Cocaine withdrawal

Hitori, A. Suddath, R.L. and Wyatt, R.J. Effect of chronic cocaine withdrawal on dopamine uptake sites in the rat frontal cortex. Biol Psychiatry 25 (Suppl) 48A, 1989. 

Stimulant Withdrawal (Cocaine Withdrawal and Amphetamine Withdrawal)... 

There are no proven pharmacotherapies for treatment of cocaine or amphetamine dependence. Disulfiram, however, shows some promise in randomized controlled trials for treating cocaine dependence at doses of 250 mg daily, especially in combination with CBT.45 Its mechanism of action for treating cocaine dependence is not known, but may be due to its inhibition of the dopamine P-hydroxylase enzyme that converts DA to NE in the brain. The resulting increase in DA levels may counter the DA-deficient state that is believed to underlie cocaine withdrawal and craving. 

Malcolm R., Hutto B., Philips J., Ballenger J. Pergolide mesylate treatment of cocaine withdrawal. 

Modified and reprinted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.r text revision. Washington, DC American Psychiatric Association, 2000 Sofuoglu M, Dudish-Poulsen S, Poling J, et al. The effect of individual cocaine withdrawal symptoms on outcomes in cocaine users. Addict Behav 2005,30 1 125-1134 and Patten SB, Barbui C. Drug-induced depression a systematic review to inform clinical practice. Psychoth Psychosom 2004 73 207-215. 

Baumann MH, Rothman RB. (1998). Alterations in serotonergic responsiveness during cocaine withdrawal in rats similarities to major depression in humans. Biol Psychiatry. 44(7) 578-91. 

Wu JC, Bell K, Najafi A, Widmark C, Keator D, Tang C, Klein E, Bunney BG, Fallon J, Bunney WE. (1997). Decreasing striatal 6-FDOPA uptake with increasing duration of cocaine withdrawal. Neuropsychopharmacology. 17(6) 402-9. 

Tran-Nguyen LT, Fuchs RA, Coffey GP, Baker DA, O Dell LE, et al. 1998. Time-dependent changes in cocaine-seeking behavior and extracellular dopamine levels in the amygdala during cocaine withdrawal. Neuropsychopharmacology 19... 

The cocaine addict most often presents during withdrawal after a binge of cocaine use. Cocaine withdrawal is not life threatening and does not require medical intervention in the same sense as alcohol or opiate withdrawal. It is, however, associated with a profound depression that can render the addict suicidal for 24-48 hours. The crashing cocaine addict should be assessed for suicide risk and, if indicated, the patient should be monitored in an emergency psychiatric setting or may require a brief 1-2 day inpatient psychiatric admission until the withdrawal resolves and the suicide risk is relieved. 

Unlabeled Uses Treatment of cataplexy associated with narcolepsy, cocaine withdrawal, neurogenic pain, panic disorder... 

It is known, however, that drugs are readily available in many prisons, and the rate of adverse incidents and the time and effort spent in detecting smuggling of drugs in has been enough to persuade some authorities that at least the basics of treatment should be available. The most routine option has become to provide a detoxification for opiate misusers, with for instance lofexidine or dihydrocodeine, and also benzodiazepines will often be issued if there is a history of abuse of these and it is intended to avoid the possibility of fits with a short withdrawal course. The adverse incidents in custody and prisons have included some deaths in users of crack cocaine, with physical explanations postulated but no very satisfactory treatment for cocaine withdrawal indicated. Prison services have typically been wary of methadone, and in favouring lofexidine use it was encouraging that a randomized double-blind trial carried out by prison specialists found lofexidine to be as effective as methadone in relief of withdrawal symptoms (Howells et al. 2002). 

Extern, Irl L., David A. Gross, and Mark S. Gold. 1989. "Bromocriptine Treatment of Cocaine Withdrawal Symptoms." American Journal of Psychiatry 146 403. 

Markou, Athina, and George F. Koob. 1991. "Postcocaine Anhedonia An Animal Model of Cocaine Withdrawal." Neuropsychopharmacology 4 17-26. 

Stimulation Thresholds Observed in a Rat Model of Cocaine Withdrawal." Neu ropsychopharmacology 7 213-24. 

Mendelson, Jack, S. Tech, U. Lange, Nancy Mello, R. Weiss, and A. Skupny. 1987. "Hyperprolactinemia During Cocaine Withdrawal." National Institute on Drug Abuse Research Monograph Series 81 67-73. 

Weiss, Friedbert, Athina Markou, Marge T. Lorang, and George F. Koob. 1992b. "Basal Extracellular Dopamine Levels in the Nucleus Accumbens Are Decreased During Cocaine Withdrawal After Unlimited-Access Self-Administration." Brain Research 593 314-18. 

The association of cocaine withdrawal with hypothalamic-pituitary-adrenal axis dysregulation has previously been reported and may be important in understanding vulnerability to stress response and relapse (70). The hypothesis that withdrawn cocaine-dependent patients would have higher cerebrospinal fluid concentrations of corticotropin-releasing hormone than healthy controls has been tested in 29 cocaine-dependent men (mean age 40 years) who were abstinent for a minimum of 8 days (mean 29 days) and 66 healthy controls. The subjects were 21 African Americans, two Hispanics, and six Caucasians. There were no significant differences in cerebrospinal... 

Corned answer = B. The anxiolytic properties of benzodiazepines, such as lorazepam, make them the drugs of choice in treating the anxiety and agitation of cocaine withdrawal. Lorazepam also has hypnotic properties. Phenobaibital has hypnotic properties but if s anxiolytic properties are inferior to those of the benzodiazepines. Cocaine itself could countered the agitation of withdrawal but its use would not be proper therapy. Hydroxyzine, an antihistaminic, is effective as an hypnotic and is sometimes used to deal with anxiety especially if emesis is a problem. Fluoxetine is an antidepressant with no immediate effects on anxiety. 

An advantage of the hedonic allostasis hypothesis is that it provides a basis for the strong comorbidity of drug addiction and depression. However, this relationship with depression is also the limit of the hypothesis. Thus, anhedonia induced by cocaine withdrawal has been proposed as a model of depression also on the basis of the observation that antidepressants reverse withdrawal-induced anhedonia yet, antidepressants do not provide a treatment for drug addiction. Therefore it would appear that anhedonia is a condition associated to drug addiction but is not the factor that sustains its maintenance or its resumption after a long period of abstinence. 

Markou A, Koob GF (1991) Postcocaine anhedonia. An animal model of cocaine withdrawal. Neuropsychopharmacology 4 17-26. 

Wood DM, Lai H (1987) Anxiogenic properties of cocaine withdrawal. Life Sci 7 1431-1436. 

However, in a recent report, extrapyramidal symptoms of classic muscle stiffness and cogwheel rigidity at the elbow occurred during the crash phase of a 40-year-old man s cocaine withdrawal (132). 

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