Pharmacological Treatments for Cocaine Dependence: Is There Something New?

Laurent      Karila; Michel      Reynaud; Henri-Jean      Aubin; Benjamin      Rolland; Dewi      Guardia; Olivier      Cottencin; Amine      Benyamina

Abstract

Introduction: There is no specific and approved treatment, by regulatory authorities, for cocaine dependence. Therefore, developing new medications for the treatment of this disease continues to be a research priority. Recent advances in neurobiology and brain imaging studies have suggested several promising pharmacological approaches.

Materials and Methods: Literature searches were conducted for the period from January 1990 to February 2011 using PubMed, EMBASE, PsycInfo, the NIDA research monograph index and the reference list of clinicaltrials.gov, which are the main electronic sources of ongoing trials.

Results: Recent controlled clinical studies have highlighted some very promising medications, especially glutamatergic (NAcetylcysteine, modafinil, topiramate) and GABAergic (vigabatrin) agents, agonist replacement therapy (sustained-release methylphenidate, d-amphetamine) and dopamine agents (disulfiram). Additionally, immunotherapy is a new and promising pharmacological approach.

Conclusion: Promising pharmacological approaches have emerged for the treatment of cocaine dependence, but larger, randomized, placebo- controlled studies are needed for some medications. Preclinical studies suggest new targets of interest in cocaine dependence. The optimal therapeutic platform is the combination of pharmacotherapies with behavioral therapies.

Keywords: Cocaine, dependence, addiction, pharmacotherapy, vaccine, immunotherapy, clinical trials, N-Acetylcysteine, modafinil, vigabatrin, disulfiram, Aripiprazole, methylphenidate, psychostimulant, multifactorial, paraphernalia, dopamine, serotonin, norepinephrine, endocannabinoid, acetylcholine