We always say that single positive studies need replication, and here comes one. In 2012 a randomized trial found that the combination of topiramate and adderall xr worked better than placebo at helping people with frequent cocaine use stay sober. This new study [Link] sought to replicate that, although it was by the same research group as the original─Columbia’s New York State Psychiatric Institute. The new addition is a larger study looked at 127 patients over 3 months.

Published On: 8/8/20

Duration: 2 minutes, 16 seconds

Transcript:

We always say that single positive studies need replication, and here comes one. In 2012 a randomized trial found that the combination of topiramate and adderall xr worked better than placebo at helping people with frequent cocaine use stay sober. This new study sought to replicate that, although it was by the same research group as the original ─ Columbia’s New York State Psychiatric Institute. The new addition is a larger study looked at 127 patients over 3 months.

This was a double-blind, randomized placebo-controlled trial, that tested Adderall XR combined with topiramate against placebo. Like the earlier study, the treatment worked on the primary measure – how many patients stayed sober for at least 3 weeks. None on the placebo achieved that, but 14% on the treatment did.

1 in 5 patients had to stop the treatment due to elevated blood pressure or pulse. Otherwise, they were well tolerated.

Which begs the question, why not use topiramate on its own? Topiramate does have promising pilot studies on its own, as does Adderall ─ though that particular study was in people with ADHD who used cocaine. But clinically I would start with the less risk of the two ─ topiramate ─ before considering the combination.

Topiramate was titrated over 6 weeks to a max of 100 mg bid and adderall XR over 2 weeks to a max of 60mg/day.  The authors suggest the cardiovascular risks may have been lessened if adderall was titrated slower.

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