title: Pharmacotherapy of cerebral ischemia in cocaine dependence.
abstract: This paper will examine how cerebral perfusion deficits in cocaine abusers may be a target for pharmacotherapy. The review covers five areas: (1) cerebral ischemia and neuropsychological impairment in cocaine abusers, (2) neuroimaging evidence for cerebral perfusion defects in cocaine abusers, (3) mechanisms for cocaine induced cerebral thrombosis, (4) neurotoxicity from cerebral ischemia and excitatory amino acids, (5) glutamate antagonists as potential treatment agents for cocaine induced neurotoxicity. Several pharmacotherapies are suggested including antiplatelet agents and excitatory amino acid (EAA) antagonists such as lamotrigine. Clinical trials in cocaine abusers with cerebral perfusion defects are indicated and EAA antagonists hold promise as they are developed for stroke treatment.
authors.affiliation: VA Connecticut Healthcare System, Psychiatry, West Haven 06516, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Kosten
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects; D002545:Brain Ischemia / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000503:physiopathology; D003072:Cognition Disorders / Q000209:etiology*; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D005260:Female; D018698:Glutamic Acid / Q000009:adverse effects; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000139:chemically induced / Q000188:drug therapy; D008297:Male; D009410:Nerve Degeneration / Q000139:chemically induced / Q000503:physiopathology; D009483:Neuropsychological Tests; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011877:Radionuclide Imaging; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology
chemical_list: D018691:Excitatory Amino Acid Antagonists; D010975:Platelet Aggregation Inhibitors; D018698:Glutamic Acid; D003042:Cocaine; D001241:Aspirin