title: Carvedilol does not reduce cocaine use in methadone-maintained cocaine users.
abstract: The goal of this study was too test the efficacy of carvedilol (CAR), an adrenergic blocker, for reducing cocaine use in individuals with cocaine use disorder (CUD). We conducted a 17-week, double-blind, randomized controlled trial with 3 treatment arms: 25mg CAR, 50mg CAR, and placebo.
  
  
  
  One hundred and six treatment-seeking opioid and cocaine-dependent participants, who were also maintained on methadone during study participation, were randomized to placebo (n=34), 25mg/day CAR (n=37) or 50mg/day CAR (n=35). The main outcome measures were cocaine and opioid use as assessed by urine drug screening and self-reported drug use.
  
  
  
  No significant group differences were found for treatment retention with 56% of the placebo, 76% of the 25mg and 66% of the 50mg CAR groups (p>0.05) completing treatment. The percentage (SD) of cocaine positive urines during the trial showed an overall treatment effect: 59.2 (38.9) for the placebo, 50.8 (33.8) for the 25mg and 75.1 (33.2) for the 50mg CAR group. In post hoc comparisons, neither the 25 nor 50mg CAR condition differed significantly from the placebo; however, the 25mg CAR group had a significantly lower proportion of cocaine-positive urines than the 50mg group. No significant group differences were found for the percentage of self-reported days of cocaine abstinence during the trial: 72.9 (25.3) for placebo, 72.9 (29) for CAR 25mg, and 59.3 (31.7) for CAR 50mg. Significant groups differences in the proportion of opioid positive urines submitted were not observed (p>0.05). Baseline cocaine withdrawal severity did not predict treatment response (p>0.05).
  
  
  
  These findings did not support the efficacy of CAR for the treatment of cocaine use in cocaine and opioid dependent participants maintained on methadone. Further, CAR doses >25mg should not be used to avoid possible increases in cocaine and opioid use.
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States. Electronic address: Mehmet.Sofuoglu@yale.edu.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sofuoglu
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States.
authors.forename: James
authors.initials: J
authors.lastname: Poling
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States.
authors.forename: Theresa
authors.initials: T
authors.lastname: Babuscio
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States.
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Gonsai
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States.
authors.forename: Kevin
authors.initials: K
authors.lastname: Severino
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States.
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002227:Carbazoles / Q000008:administration & dosage / Q000494:pharmacology*; D000077261:Carvedilol; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods*; D011412:Propanolamines / Q000008:administration & dosage / Q000494:pharmacology*; D017211:Treatment Failure
chemical_list: D000319:Adrenergic beta-Antagonists; D000701:Analgesics, Opioid; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008691:Methadone
keywords: Adrenergic blocker; Carvedilol; Clinical trial; Cocaine use disorder