Cocaine withdrawal syndrome

Dependence and withdrawal can occur with all of the stimulants. Cocaine is one of the most strongly reinforcing drugs in self-administration paradigms in animals and also has a psychological withdrawal syndrome. A typical pattern of withdrawal includes a ravenous appetite, exhaustion, and mental depression, which may last for several days after the drug is withdrawn. Because tolerance develops quickly, abusers may take large doses, compared with those used medically, for example, as anorexiants. 

LSD produces a rapid and complete tolerance, but it is not powerfully reinforcing the way drugs of abuse like cocaine and heroin are. LSD does not produce any known withdrawal syndrome (Abraham et al. 1996). It does not produce positive reinforcement in animal self-administration models. Concurrently in humans, it does not lead to patterns of repeti-... 

Heimer L, Zahm DS, ChurchUl L, Kalivas PW, Wohltman C (1991) Specificity in the projection patterns of accumbal core and medial shell in the rat. Neuroscience 41 89-125 Hemby SE, No C, Koves TR, Smith JE, Dworkin SI (1997) Differences in extracellular dopamine concentration in the nucleus accumbens during response-dependent and response-independent cocaine administration in the rat. Psychopharmacology 133 7-16 Hildebrand BE, Nomikos GG, Hertel P, Sclrilstrom B, Svensson TH (1998) Reduced dopamine output in the nucleus accumbens but not the prefrontal cortex in rats displaying mecamylamine-precipitated nicotine withdrawal syndrome. Brain Res 779 214-225 Ikemoto S (2003) Involvement of the olfactory tubercle in cocaine reward intracranial selfadministration studies. J Neurosd 23 9305-9311... 

The clinical effects of amphetamine and its derivatives are very similar to those of cocaine, although the euphoria they produces may be less intense but last longer than that due to cocaine. Signs of amphetamine intoxication, toxicity, overdose, sensitization by production of an acute paranoid psychosis, and withdrawal syndrome are all similar to those described above for cocaine. 

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). 

Cocaine is usually legally classified as an addictive drug though withdrawal doesn t cause the abstinence syndrome seen in junkies. Cocaine withdrawal causes symptoms similar to those seen in withdrawal from amphetamines — depression, fetigue and listlessness. 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Nervous system Seizures have been attributed to flumazenil [104, 105, 106, 107, 108, 109, 110, 111 ], including status epilepticus [112, 113 ], which can be fatal. However, it has been suggested that seizures are not a toxic effect of flumazenil, but are in many cases instead due to unmasking of the anticonvulsant effect of the benzodiazepine or to a severe benzodiazepine-withdrawal syndrome furthermore, in some cases they may be due to other drugs taken at the same time, such as tricyclic antidepressants [1143]. Thus, it has been recommended that flumazenil should not be given to patients who have used benzodiazepines for seizure disorders or to patients who have taken other drugs that increase the risk of seizures (e.g. bupropion, ciclosporin, cocaine, cyclic antidepressants, isoniazid, lithium, methylxanthines, monoamine oxidase inhibitors, and propoxyphene). 

Modafinil (Fig. 18.12) is also a non-amfetamine with psychostimulant properties, used for the treatment of narcolepsy, ADHD, obstruaive sleep apnea/hypopnea syndrome and may show potential for the treatment of cocaine withdrawal symptoms. Inspection of the structural representation indicates that modafinil contains a diphe-nylmethyl moiety and hence is dissimilar from an... 

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