Cocaine neuroleptic drugs

The hypothetical link between dopamine and schizophrenia was forged by two reciprocally related findings. The first was that potent dopamine agonist stimulants like d-amphetamine and cocaine could cause a psychosis that was schizophrenia-like, in that it had auditory hallucinations and paranoia. The second was that the neuroleptic drugs that were effective in reversing both schizophrenia and stimulant-induced psychosis were dopamine blockers. Moreover, the antipsychotic potency of the neuroleptics was proportional to their binding affinity to the D2 receptor. 

In a retrospective study of 116 patients taking neuroleptic drugs, 42% of cocaine users versus 14% of non-users developed dystonic reactions (640). This suggests that the use of cocaine may be a major risk factor for acute dystonic reactions secondary to the use of neuroleptic drugs. 

Cocaine and neuroleptic drugs can both cause hyperthermia and the authors proposed that the combination of cocaine and risperidone may have caused this problem. 

This has been confirmed in a 2-year study on the island of Curasao in the Netherlands Antilles, where cocaine and cannabis are often abused (168). The sample consisted of 29 men with neuroleptic-induced acute dystonias aged 17-45 years who had received high potency neuroleptic drugs in the month before admission 9 were cocaine users and 20 non-users. Cocaine use was a major risk factor for neuroleptic-induced acute dystonia and should be added to the list of well-known risk factors such as male sex, younger age, neuroleptic dose and... 

Kosten TR, Kleber HD Rapid death during cocaine abuse a variant of the neuroleptic malignant syndrome Am J Drug Alcohol Abuse 14 335-346, 1988 Kosten TR, Kleber HD, Morgan C Treatment of cocaine abuse with buprenorphine. Biol Psychiatry 26 637—639, 1989... 

Kosten, T.R. and Kleber, H.D. Rapid death during cocaine abuse a variant of neuroleptic malignant syndrome. Am J. Drug Alcohol Abuse. 14 335, 1988. 

The diagnosis of GHB withdrawal may be difficult because it is similar to sedative or alcohol withdrawal syndromes, as well as to withdrawal from sympathomimetic agents such as cocaine, methamphetamine, and ecstasy. GHB withdrawal may also be confused with serotonin syndrome (a reaction caused by a combination of drugs, one of which increases serotonin levels in the body, such as Prozac) and neuroleptic malignant syndrome (a rare reaction to an antiseizure medication). 

The discovery that the first antipsychotic drugs in the early 1950s, such as chlorpromazine, work in vitro by blocking dopamine receptors led to the hypothesis that schizophrenia was the result of excessive dopaminergic neurotransmission (54, 55). Supporting this hypothesis, dmgs that enhance dopamine action (e.g., cocaine, amphetamines, and L-DOPA) worsen the symptoms of schizophrenia. However, it is clear that 1) not all patients respond to neuroleptic treatment and 2) not all symptoms are reversed by the medication. 

Abusive drugs + 700-1200 morphine and derivatives, benzodiazepines, cocaine, hallucinogens, tetrahydro-cannabinols, tricyclic antidepressants, neuroleptics... 

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