Background: In the field of dual diagnosis, physicians are frequently presented with
pharmacological questions. Questions about the risk of developing psychotic symptoms in cocaine users
who need treatment with dopaminergic drugs could lead to an undertreatment.
Objective: Review the presence of psychotic symptoms in patients with cocaine abuse/dependence, in
treatment with dopaminergic drugs.
Methods: Systematic PubMed searches were conducted including December 2014, using the keywords:
“cocaine”, dopaminergic drug (“disulfuram-methylphenidate-bupropion-bromocriptine-sibutramineapomorphine-
caffeine”) and (“psychosis-psychotic symptoms-delusional-paranoia”). Articles in English,
Spanish, Portuguese, French, and Italian were included. Articles in which there was no history of cocaine
abuse/dependence, absence of psychotic symptoms, systematic reviews, and animal studies, were
Results: 313 papers were reviewed. 7 articles fulfilled the inclusion-exclusion criteria. There is a clinical
trial including 8 cocaine-dependent patients using disulfiram in which 3 of them presented psychotic
symptoms and 6 case-reports: disulfuram (1), methylphenidate (1), disulfiram with methylphenidate (2), and
bupropion (2), reporting psychotic symptoms, especially delusions of reference and persecutory ideation.
Conclusion: Few cases have been described, which suggests that the appearance of these symptoms is
infrequent. The synergy of dopaminergic effects or the dopaminergic sensitization in chronic
consumption are the explanatory theories proposed by the authors. In these cases, a relationship was
found between taking these drugs and the appearance of psychotic symptoms. Given the low number of
studies found, further research is required. The risk of psychotic symptoms seems to be acceptable if we
compare it with the benefits for the patients but a closer monitoring seems to be advisable.