Smoking and alcohol dependence cause poor health, frequently co-occur, and can be difficult to treat simultaneously. A drug that can effectively treat both conditions would be of great clinical interest.

Researchers who found that oral topiramate improved alcohol outcomes* in people with alcohol dependence examined whether the drug could also promote smoking cessation. Using data from their previous randomized controlled trial, they compared smokers** with alcohol dependence who had received topiramate (escalating dose of 25–300 mg per day for 12 weeks; n=45) with those who had received placebo (n=49).

• At 12 weeks, 17 percent of the topiramate group and 7 percent of the placebo group reported abstinence from smoking.

• In analyses adjusted for potential confounders, the topiramate group was significantly more likely than the placebo group to report abstinence from smoking (odds ratio 4.5) and to have lower serum cotinine levels.

• Although serious adverse effects were not observed, the topiramate group was significantly more likely than the placebo group to report paresthesia and weight loss.

Comments by Kevin L. Kraemer, MD, MSc:

This small post-hoc analysis of a subgroup of subjects in a randomized trial indicates that oral topiramate has the potential to treat both alcohol dependence and smoking. Larger randomized trials should be completed to confirm the short-term effects of oral topiramate and to assess long-term efficacy after the drug has been discontinued.

*3 fewer drinks per day and 26 percent more abstinent days in subjects assigned to topiramate versus placebo (Lancet 2003;361[9370]:1677–1685)

**Smoked at least 1 cigarette per day

Reference:

Johnson BA, Ait-Daoud N, Akhtar FZ, et al. Use of oral topiramate to promote smoking abstinence among alcohol-dependent smokers: a randomized controlled trial. Arch Intern Med. 2005;165(14):1600–1605.

Reprinted with permission from Alcohol and Health: Current Evidence.