topiramate and Heroin-Dependence

A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante® OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante® OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug.

Topics: Adrenal Cortex Hormones; Alcoholism; Anticonvulsants; Choroidal Effusions; Follow-Up Studies; Glaucoma, Angle-Closure; Heroin Dependence; Humans; Male; Microscopy, Acoustic; Middle Aged; Mydriatics; Myopia; Tomography, Optical Coherence; Topiramate

The alpha2-adrenergic agonist clonidine is the mainly used drug for the opiate withdrawal. Its efficacy and tolerance in treating withdrawal symptoms is, however, suboptimal. The pharmacological profile of topiramate suggests it could be rather valuable for opiate withdrawal, as there is some evidence that topiramate acts, among others, through inhibition of alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors, which play an important role in the withdrawal-induced activation of the locus coeruleus (LC) by glutamate. Three patients undergoing an inpatient opiate detoxification program were treated with topiramate, which achieved a nearly complete control of withdrawal symptoms.

Topics: Adrenergic alpha-Agonists; Adult; Anticonvulsants; Clonidine; Female; Fructose; Heroin Dependence; Humans; Liver Function Tests; Male; Opioid-Related Disorders; Seizures; Substance Withdrawal Syndrome; Topiramate