title: New treatments for cocaine dependence: a focused review.
abstract: Cocaine, already a significant drug problem in North and South America, has become a more prominent part of the European drug scene. Cocaine dependence has major somatic, psychological, psychiatric, socio-economic, and legal implications. No specific effective pharmacological treatment exists for cocaine dependence. Recent advances in neurobiology have identified various neuronal mechanisms implicated in cocaine addiction and suggested several promising pharmacological approaches. Data were obtained from Medline, EMBASE, and PsycINFO searches of English-language articles published between 1985 and June 2007 using the key words: cocaine, addiction, cocaine dependence, clinical trials, pharmacotherapy(ies) singly and in combination. Large well-controlled studies with appropriate statistical methods were preferred. Pharmacological agents such as GABA agents (topiramate, tiagabine, baclofen and vigabatrin) and agonist replacement agents (modafinil, disulfiram, methylphenidate) seem to be the most promising in treatment of cocaine dependence. The results from trials of first- and second-generation neuroleptics are largely negative. Aripiprazole, a partial dopaminergic agonist that may modulate the serotonergic system, shows some promise. Preliminary results of human studies with anti-cocaine vaccine, N-acetylcysteine, and ondansetron, are promising, as are several compounds in preclinical development. While no medication has received regulatory approval for the treatment of cocaine dependence, several medications marketed for other indications have shown efficacy in clinical trials. An anti-cocaine vaccine and several compounds in preclinical development have also shown promise. Findings from early clinical trials must be confirmed in larger, less selective patient populations.
authors.affiliation: INSERM, U797, Hospital Department Frédéric Joliot, 12BM, Orsay, France. laurent.karila@pbr.aphp.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Karila
authors.forename: David
authors.initials: D
authors.lastname: Gorelick
authors.forename: Aviv
authors.initials: A
authors.lastname: Weinstein
authors.forename: Florence
authors.initials: F
authors.lastname: Noble
authors.forename: Amine
authors.initials: A
authors.lastname: Benyamina
authors.forename: Sarah
authors.initials: S
authors.lastname: Coscas
authors.forename: Lisa
authors.initials: L
authors.lastname: Blecha
authors.forename: William
authors.initials: W
authors.lastname: Lowenstein
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Martinot
authors.forename: Michel
authors.initials: M
authors.lastname: Reynaud
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Lépine
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology; D015259:Dopamine Agents / Q000627:therapeutic use; D018682:GABA Agents / Q000627:therapeutic use; D006801:Humans
chemical_list: D015259:Dopamine Agents; D018682:GABA Agents