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HANDBOOK OF PSYCHIATRIC DRUGS - PART 10

Với tỷ lệ tái phát cao với điều trị tâm lý xã hội một mình, đã được sự quan tâm đáng kể trong sự phát triển của pharmacotherapies cho sự phụ thuộc cocaine. Báo cáo trường hợp và nghiên cứu thí điểm mở đ | DRUGS FOR TREATING SUBSTANCE ABUSE DISORDERS 241 least a month of these medications for patients with problem drinking and not be discouraged by the fact that some patients will not benefit. Medications for Cocaine Dependence Given the high relapse rates with psychosocial treatment alone there has been considerable interest in the development of pharmacotherapies for cocaine dependence. Case reports and open pilot studies have suggested that a variety of agents may be effective but double-blind trials have provided disappointingly inconsistent results. Surveys have demonstrated that many addiction medicine specialists are using medicines to treat cocaine dependence despite the lack of evidence of a standard sufficient for FDA approval. The most widely prescribed medicines for cocaine dependence are antidepressants. Depression occurs frequently in cocaine addicts and it is possible that antidepressants may correct neurotransmitter deficiencies associated with cocaine use. The best evidence relates to desipramine but early reports of its effectiveness in preventing relapse were subsequently contradicted and its efficacy for more than 6-12 weeks was questioned. Typical desipramine doses are the same as for the treatment of depression. Concurrent use of an antidepressant and cocaine increases the risk of additive cardiotoxicity and patients who recommence cocaine use during treatment should be assessed for this possibility. Although antipsychotic drugs have been proposed on the grounds that blockade of dopamine receptors would attenuate the euphoric response to cocaine experience treating patients with schizophrenia and cocaine dependence do not support this hypothesis. Furthermore cocaine use is associated with dopamine depletion and may therefore increase the risk of extrapyramidal effects. Psychomotor stimulants have been suggested as an agonist maintenance treatment strategy. Although early clinical reports suggested stimulants might exacerbate cocaine dependence .