Short-term Treatment of Cocaine and/or Methamphetamine Abuse With Vigabatrin: Ocular Safety Pilot Results

Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 90 Bergen Street, Newark, NJ 07103, USA.
Archives of Ophthalmology (Impact Factor: 4.4). 10/2006; 124(9):1257-62. DOI: 10.1001/archopht.124.9.1257
Source: PubMed


To evaluate the ocular safety of short-term use of vigabatrin to treat cocaine and/or methamphetamine addiction.
Individuals who were actively using cocaine and/or methamphetamine were eligible for enrollment. Enrolled subjects were scheduled for comprehensive eye examinations at the beginning and end of the study. Visual field testing was performed at baseline and 1 week, 4 weeks, 8 weeks, and 1 month or more after discontinuing vigabatrin. Twenty-eight subjects received at least 1 dose of vigabatrin; however, only 20 subjects continued beyond the initial escalating vigabatrin dose phase to the treatment phase. Of these 20 subjects, 18 completed the study with full follow-up. Visual fields were evaluated subjectively by 2 glaucoma specialists and analyzed objectively for group and individual changes in quadrant mean sensitivity. The objective analysis was also repeated for superior field quadrants after excluding the uppermost peripheral points to minimize the eyelid effect. The main outcome measures were change of visual field, visual acuity, and ocular adverse effects.
Vigabatrin seemed to help treat cocaine and/or methamphetamine addiction. Of 18 subjects, 16 had negative test results for cocaine and methamphetamine use during the last 6 weeks of the trial. No ocular adverse events were detected. The subjective evaluation did not reveal visual field constriction in any of the 18 evaluable participants. Objective group and individual analyses for quadrant mean sensitivity did not show any change from baseline in any quadrant. No changes in visual acuity were noted.
In this short-term pilot study, vigabatrin seemed to help treat cocaine and/or methamphetamine abuse. There was no evidence of ocular or visual field adverse effects.

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    • "Although the study delivered promising findings a weakness was the lack of a control group. Another study that examined the same 18 participants for their safety outcomes did not find changes in the visual field or abnormalities in visual acuity or ocular adverse effects (Fechtner et al., 2006). "
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    • "Controlled clinical trials are underway to further evaluate the effects of vigabatrin (Brodie et al., 2005). It should be noted that while visual safety for short term use in cocaine addicts is established (Fechtner et al., 2006), peripheral field damage with long term use is possible (The Royal College of Ophthalmology, 2008). While facilitation of GABA activity shows evidence for reducing cocaine use, it is interesting to note that tiagabine, which blocks presynaptic release of GABA, also decreased cocaine use and increased abstinence rate in two controlled clinical trials (Gonzalez et al., 2007; Gonzalez et al., 2003). "
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    • "Furthermore, for women of childbearing age receiving vigabatrin, the findings can aid informed discussion about potential visual aspects of vigabatrin toxicity . The latter should also be placed in the context of possible unplanned pregnancy in women treated with vigabatrin as an antiaddiction drug (Fechtner et al., 2006). "
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