Pharmacotherapy for Primary Stimulant Dependence

More than 40 medications have been investigated but none have shown consistent efficacy for primary cocaine or amphetamine dependence. These medications include dopaminergic agonists, antidepressants, and more recently disulfiram, selegiline, and a cocaine vaccine (see Table 5—2 for summary). Studies have been relatively brief and have focused on abstinence initiation rather than on relapse prevention, but even these modest treatment goals have not been attained. The focus in the discussion that follows is on pharmacotherapies for cocaine dependence, because very few clinical trials have been completed with amphetamine-dependent patients. Furthermore, none of the studies of amphetamine dependence have shown results different from those described for cocaine dependence (Rawson et al. 2002b Srisurapanont et al. 2001). 

Amantidine, bromocriptine, mazindol, pergolide, cabergoline, L-dopa/carbidopa, pramipexole, ABT-431, catecholamine metabolism inhibitors (disulfiram, phenelzine, selegiline), amineptine Methylphenidate, /-amphetamine, tropanes, GBR-12909 (partial agonist that may also act as antagonist), modafinil, coca tea 

Antipsychotics (conventional agents have nonspecific dopamine receptor antagonsim atypical agents also have serotonin antagonist activity), ecopipam, GBR-12909 and other partial dopamine agonists (may be functional antagonists) 

Vigabatrin (not marketed in United States), tiagabine, topiramate, gabapentin, carbamazepine, lamotrigine 

Findings are mixed, but some agents are promising (e.g., disulfiram, amineptine) class deserves further smdy. 

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