title: Antipsychotic medications for cocaine dependence.
abstract: BACKGROUND
  Cocaine dependence is a public health problem characterized by recidivism and a host of medical and psychosocial complications. Cocaine dependence remains a disorder for which no pharmacological treatment of proven efficacy exists, although considerable advances in the neurobiology of this addiction could guide future medication development
  
  
  OBJECTIVE
  To evaluate the efficacy and the acceptability of antipsychotic medications for cocaine dependence
  
  
  METHODS
  We searched the following sources: MEDLINE (1966 to October 2006), EMBASE (1980 to October 2006), CINAHL (1982 to October 2006), Cochrane Drug and Alcohol Group Specialised Register (October 2006). We also searched the reference lists of trials, the main electronic sources of ongoing trials (National Research Register, meta-Register of Controlled Trials; Clinical Trials.gov) and conference proceedings likely to contain trials relevant to the review. All searches included also non-English language literature.
  
  
  METHODS
  All randomised controlled trials and controlled clinical trials with focus on the use of any antipsychotic medication for cocaine dependence
  
  
  METHODS
  Two authors independently evaluated the papers, extracted data, rated methodological quality
  
  
  RESULTS
  Seven small studies were included (293 participants): the antipsychotic drugs studied were risperidone, olanzapine and haloperidol. No significant differences were found for any of the efficacy measures comparing any antipsychotic with placebo. Risperidone was found to be superior to placebo in diminishing the number of dropouts, four studies, 178 participants, Relative Risk (RR) 0.77 (95% CI 0.77 to 0.98). Most of the included studies did not report useful results on important outcomes such as side effects, use of cocaine during treatment and craving. The results on olanzapine and haloperidol come from studies too small to give conclusive results.
  
  
  CONCLUSIONS
  Although caution is needed when assessing results from a limited number of small clinical trials there is no current evidence, at the present , supporting the clinical use of antipsychotic medications in the treatment of cocaine dependence. Furthermore, most of the included studies did not report useful results on important outcomes such as side effects, use of cocaine during the treatment and craving. Aiming to answer the urgent demand of clinicians, patients, families, and the community as a whole for an adequate treatment for cocaine dependence, larger randomised investigations should be designed investigating relevant outcomes and reporting data to allow comparison of results between studies. Moreover some efforts should be done also to investigate the efficacy of other type medications, like anticonvulsant, currently used in clinical practice.
authors.affiliation: ASL RM/E, Deparment of Epidemiology, Via di Santa Costanza 53, Rome, Lazio, Italy, 00198. amato@asplazio.it
authors.forename: L
authors.initials: L
authors.lastname: Amato
authors.forename: S
authors.initials: S
authors.lastname: Minozzi
authors.forename: P P
authors.initials: PP
authors.lastname: Pani
authors.forename: M
authors.initials: M
authors.lastname: Davoli
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D000077152:Olanzapine; D016032:Randomized Controlled Trials as Topic; D018967:Risperidone / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine