title: Dopamine agonists for the treatment of cocaine dependence.
abstract: BACKGROUND
  Cocaine dependence is a disorder for which no pharmacological treatment of proven efficacy exists, advances in the neurobiology could guide future medication development
  
  
  OBJECTIVE
  To investigate the efficacy and acceptability of dopamine agonists alone or in combination with any psychosocial intervention for the treatment of cocaine abuse and dependence
  
  
  METHODS
  We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL, PsycINFO in June 2011 and researchers for unpublished trials
  
  
  METHODS
  Randomised and controlled clinical trials comparing dopamine agonists alone or associated with psychosocial intervention with placebo, no treatment, other pharmacological interventions
  
  
  METHODS
  Two authors independently assessed trial quality and extracted data
  
  
  RESULTS
  Twenty three studies, 2066 participants, met the inclusion criteria. Comparing any dopamine agonist versus placebo, placebo performed better for severity of dependence, four studies, 232 participants, SMD 0.43 (95% CI 0.15 to 0.71), depression, five studies, 322 participants, SMD 0.42 (95% CI 0.19 to 0.65) and abstinent at follow up RR 0.57 (95% CI 0.35 to 0.93). No statistically significant different for the other outcomes considered. Comparing amantadine versus placebo, results never gain the statistical significance, but there is a trend in favour of amantadine for dropouts and depression. Results on adverse events and depression, were in favour of placebo although the difference do not reach the statistical significance. Comparing bromocriptine and Ldopa/Carbidopa versus placebo, results never reached statistical significance. Comparing amantadine versus antidepressants, antidepressants performed better for abstinence. The other two outcomes considered did not show statistically significant differences although dropouts and adverse events tended to be more common in the antidepressant group.The quality of evidence, assessed according to GRADE method, may be judged as moderate for the efficacy of any dopamine agonist versus placebo and as moderate to high for amantadine versus placebo and versus antidepressants.
  
  
  CONCLUSIONS
  Current evidence from randomised controlled trials does not support the use of dopamine agonists for treating cocaine dependence. This absence of evidence may leave to clinicians the alternative of balancing the possible benefits against the potential adverse effects of the treatment. Even the potential benefit of combining a dopamine agonist with a more potent psychosocial intervention which was suggested by the previous Cochrane review (Soares 2003), is not supported by the results of this updated review.
authors.affiliation: Department of Epidemiology, ASL RM/E, Via di Santa Costanza, 53, Rome, Italy, 00198.
authors.forename: Laura
authors.initials: L
authors.lastname: Amato
authors.forename: Silvia
authors.initials: S
authors.lastname: Minozzi
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Pani
authors.forename: Renata
authors.initials: R
authors.lastname: Solimini
authors.forename: Simona
authors.initials: S
authors.lastname: Vecchi
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Zuccaro
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
mesh_terms: D000547:Amantadine / Q000627:therapeutic use; D001971:Bromocriptine / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D003863:Depression / Q000188:drug therapy; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D018491:Dopamine Agonists; D001971:Bromocriptine; D007980:Levodopa; D000547:Amantadine