Pharmacological treatment of cocaine dependence: a systematic review.
OBJECTIVE
Cocaine dependence is a common and serious condition, associated with severe medical, psychological and social problems, including the spread of infectious diseases. This systematic review assesses critically the efficacy of pharmacotherapy for treating cocaine dependence.


METHODS
The literature search strategy included: electronic searches of Cochrane Library holdings, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; scans of reference lists of relevant articles, personal communications, conference abstracts, unpublished trials from the pharmaceutical industry and book chapters on the treatment of cocaine dependence. Randomized controlled trials (RCTs) focusing on the use of antidepressants (ADs), carbamazepine (CBZ), dopamine agonists (DAs) and other drugs used in the treatment of cocaine dependence were included. The reviewers extracted data independently, and relative risks (RR) with 95% confidence interval (CI) were estimated. Qualitative assessments were carried out using a Cochrane validated checklist. Where possible, analysis was carried out according to 'intention-to-treat' principles.


RESULTS
The search strategy generated 45 different trials. Most studied drugs were ADs (20 studies), DAs and CBZ. Data were very heterogeneous, with dropout rates within the studies between 0 and 84%. A non-significant trend favoring CBZ was found in terms of dropouts (RR 0.88; 95% CI 0.75-1.03) and results from one trial suggest that fluoxetine patients are less likely to drop out. The main efficacy outcome reported in the studies was the presence of cocaine metabolites in the urine. No significant results were found, regardless the type of drug or dose used for all relevant outcomes assessed.


CONCLUSIONS
There is no current evidence supporting the clinical use of CBZ, antidepressants, dopamine agonists, disulfiram, mazindol, phenytoin, nimodipine, lithium and NeuRecover-SA in the treatment of cocaine dependence. Larger randomized investigation must be considered, while taking into account that these time-consuming efforts should be reserved for medications showing more relevant and promising evidence. Given the high dropout rate among the test population, clinicians may wish to consider adding psychotherapeutic supportive measures aimed at keeping patients in treatment programs.
de Lima
Maurício Silva
MS
de Oliveira Soares
Bernardo Garcia
BG
Reisser
Anelise Alves Pereira
AA
Farrell
Michael
M
D000928:Antidepressive Agents / Q000627:therapeutic use*; D002220:Carbamazepine / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D003625:Data Collection; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D010352:Patient Dropouts; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D016896:Treatment Outcome
D000928:Antidepressive Agents; D018491:Dopamine Agonists; D002220:Carbamazepine