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CNS Drugs
Published in: CNS Drugs 10/2005

01-10-2005 | Review Article

Recent Advances in the Development of Treatments for Alcohol and Cocaine Dependence

Focus on Topiramate and Other Modulators of GABA or Glutamate Function

Author: Prof. Bankole A. Johnson

Published in: CNS Drugs | Issue 10/2005

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Abstract

Neuroscientific developments have promulgated interest in developing efficacious medications for the treatment of substance dependence. Previous pharmacological strategies that involve the use of relatively specific medications to alter corticomesolimbic dopaminergic neuronal activity —the critical pathway for expression of the reinforcing effects of abused drugs —have yielded modest efficacy in the treatment of alcohol dependence, and no medication has been established as a treatment for cocaine dependence. Since corticomesolimbic dopaminergic neurons interact with other neurotransmitters that modulate the effects of dopamine in the nucleus accumbens, would it not be possible to control these dopaminergic effects more reliably with a medication that acts contempora-neously on more than one neuromodulator of dopaminergic function? Further, since the long-term use of either alcohol or cocaine results in neuronal adaptations as a result of sensitisation, would the chances of effective therapy not be bolstered by administering a medication that was also able to mitigate these chronic effects? Thus, a new conceptual approach is needed.
My proposal is that a medication —in this case topiramate —that principally potentiates inhibitory GABAa receptor-mediated input and antagonises excitatory glutamatergic afferents to the corticomesolimbic dopaminergic system should have therapeutic potential in treating either alcohol or cocaine dependence or perhaps both. This is because the principal neurochemical effects of topiramate would not only serve to decrease the acute reinforcing effects of alcohol or cocaine, but might also facilitate cessation of their use following a period of long-term use by decreasing neuronal sensitisation.
This overview highlights the scientific concepts and clinical evidence for the development of topiramate in the treatment of alcohol dependence and introduces preliminary evidence to indicate that it might also have utility in treating cocaine dependence. Finally, to place the material on topiramate in context, information has been included on the utility and development of other medications that modulate GABA-or glutamate-mediated neuronal systems for the treatment of alcohol or cocaine dependence.
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Metadata
Title
Recent Advances in the Development of Treatments for Alcohol and Cocaine Dependence
Focus on Topiramate and Other Modulators of GABA or Glutamate Function
Author
Prof. Bankole A. Johnson
Publication date
01-10-2005
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 10/2005
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.2165/00023210-200519100-00005

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