Comparison of Desipramine or Carbamazepine to Placebo for Crack Cocaine‐Dependent Patients

Campbell, Jan; Nickel, Elizabeth J.; Penick, Elizabeth C.; Wallace, Dennis; Gabrielli, William F.; Rowe, Renarta; Liskow, Barry; Powell, Barbara J.; Thomas, Hallie

doi:10.1111/j.1521-0391.2003.tb00610.x

Cited by 28 publications

(8 citation statements)

References 27 publications

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“…In addition, it would have been useful to have directly compared atomoxetine with desipramine because the latter drug has been examined extensively as a pharmacotherapy for cocaine dependence. The results of clinical trials in which the therapeutic efficacy of desipramine has been evaluated have been mixed (reviewed in Lile & Nader, 2003), although a meta-analysis of six of these trials indicated that desipramine was significantly more effective at promoting abstinence compared with placebo (Levin & Lehman, 1991), and research with this drug has continued (e.g., Campbell et al, 2003; Kosten et al, 2003). Despite the benefits of this additional control condition, including yet another drug in the test phase would have further increased an already lengthy experimental protocol, which might have increased subject attrition.…”

Section: Discussionmentioning

confidence: 99%

Discriminative-stimulus, self-reported, performance, and cardiovascular effects of atomoxetine in methylphenidate-trained humans.

Lile

Stoops

Durell

et al. 2006

Experimental and Clinical Psychopharmacology

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Atomoxetine is marketed as a nonstimulant medication indicated for the treatment of attention-deficit/hyperactivity disorder in adults. Previous laboratory research suggests that atomoxetine has limited abuse potential but that some of its behavioral effects might overlap with traditional psychomotor stimulants like methylphenidate and d-amphetamine. A drug with this profile might be useful for the treatment of stimulant dependence. The aim of this experiment was to compare the discriminative-stimulus and self-reported effects of atomoxetine with methylphenidate, damphetamine, and triazolam in humans who had acquired a methylphenidate (30 mg) discrimination. Six healthy subjects with a recent history of nontherapeutic stimulant use were enrolled in this outpatient study. After subjects acquired the methylphenidate discrimination, a range of doses of methylphenidate (5-30 mg), atomoxetine (15-90 mg), d-amphetamine (2.5-15 mg), triazolam (0.06-0.375 mg), and placebo were tested. To more fully characterize the behavioral effects of atomoxetine, a battery of self-reported drug-effect questionnaires, a performance task, and cardiovascular assessments were also included. Methylphenidate and d-amphetamine increased drug-appropriate responding and produced typical stimulant-like effects (e.g., increased ratings of "Active, Alert, Energetic"). Atomoxetine partially substituted for methylphenidate (i.e., 33%-50%) and produced some dose-dependent, stimulant-like, subject-rated drug effects, although the magnitude of these effects was less than d-amphetamine and methylphenidate and generally did not attain statistical significance. These data suggest that the behavioral effects of atomoxetine overlap to a small degree with psychomotor stimulants and that it has low abuse potential.

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Section: Discussionmentioning

confidence: 99%

Discriminative-stimulus, self-reported, performance, and cardiovascular effects of atomoxetine in methylphenidate-trained humans.

Lile

Stoops

Durell

et al. 2006

Experimental and Clinical Psychopharmacology

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“…For example, desipramine resulted in a 40% decrease in ratings of cocaine craving, yet had no effect on the amount of cocaine self‐administered in the human laboratory (Fischman et al . 1990) or used in the clinic (Campbell et al . 2003).…”

Section: Methodsmentioning

confidence: 99%

Self‐administration of cocaine, cannabis and heroin in the human laboratory: benefits and pitfalls

Haney

2008

Addiction Biology

130

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The objective of this review is to describe self-administration procedures for modeling addiction to cocaine, cannabis and heroin in the human laboratory, the benefits and pitfalls of the approach, and the methodological issues unique to each drug. In addition, the predictive validity of the model for testing treatment medications will be addressed. The results show that all three drugs of abuse are reliably and robustly self-administered by non-treatment-seeking research volunteers. In terms of pharmacotherapies, cocaine use is extraordinarily difficult to disrupt either in the laboratory or in the clinic. A range of medications has been shown to significantly decrease cocaine's subjective effects and craving without decreasing either cocaine self-administration or cocaine abuse by patients. These negative data combined with recent positive findings with modafinil suggest that self-administration procedures are an important intermediary step between pre-clinical and clinical studies. In terms of cannabis, a recent study suggests that medications that improve sleep and mood during cannabis withdrawal decrease the resumption of marijuana self-administration in abstinent volunteers. Clinical data on patients seeking treatment for their marijuana use are needed to validate these laboratory findings. Finally, in contrast to cannabis or cocaine dependence, there are three efficacious Food and Drug Administration-approved medications to treat opioid dependence, all of which decrease both heroin self-administration and subjective effects in the human laboratory. In summary, selfadministration procedures provide meaningful behavioral data in a small number of individuals. These studies contribute to our understanding of the variables maintaining cocaine, marijuana and heroin intake, and are important in guiding the development of more effective drug treatment programs.

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“…No study among the six trials involving selective serotonin reuptake inhibitors (fluoxetine, paroxetine, fenfluramine) found evidence of anti-craving effects [ 21 , 25 , 27 , 28 , 33 , 36 ]). Among the trials involving dual action in 5HT and NA signaling (venlafaxine, citicoline, nefazodone, desipramine) [ 20 , 23 , 24 , 26 , 29 , 30 , 31 , 34 ], two found a statistically significant reduction in cocaine craving: one study administering long-term desipramine [ 26 ], and one study administering long-term nefazodone [ 24 ]. Mirtazapine 30 mg daily showed significant anti-craving effect in one study [ 32 ], while no effect in craving in another trial [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

“…Only one study [ 80 ] of two [ 23 , 80 ] comparing carbamazepine to placebo showed a significant decrease in craving. The anticonvulsant topiramate was found to have anti-craving effects in two [ 81 , 82 ] out of four trials [ 81 , 82 , 83 , 86 ].…”

Section: Resultsmentioning

confidence: 99%

Pharmacological Treatments for Cocaine Craving: What Is the Way Forward? A Systematic Review

et al. 2022

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Background: cocaine craving is a core feature of cocaine use disorder and remains a critical challenge for abstinence and relapse prevention. This review summarizes the anti-craving efficacy of pharmacotherapies tested for cocaine use disorder, in the context of randomized-controlled clinical trials. Objectives: we assessed the databases of the U.S. National Library of Medicine, Google Scholar, and PsycINFO, without date restrictions up to August 2022, to identify relevant studies. Study eligibility criteria, participants, and interventions: we included double-blinded randomized-controlled trials investigating pharmacotherapies for cocaine craving and/or cocaine use disorder whose outcomes included cocaine craving. Study appraisal and synthesis methods: Two authors screened studies’ titles and abstracts for inclusion, and both read all the included studies. We systematically gathered information on the following aspects of each study: title; author(s); year of publication; sample size; mean age; sample characteristics; study set-ting; whether participants were treatment-seeking; study design; craving measures; study interventions; drop-out rates; and other relevant outcomes. Results: Overall, we appraised 130 clinical trials, including 8137 participants. We further considered the drugs from the studies that scored equal to or greater than six points in the quality assessment. There was a correlation between craving and cocaine use outcomes (self-reports, timeline follow-back or urinary benzoylecgonine) in the vast majority of studies. In the short-term treatment, acute phenylalanine-tyrosine depletion, clonidine, fenfluramine, meta-chlorophenylpiperazine (m-CPP) and mecamylamine presented promising effects. In the long term, amphetamine, biperiden, carbamazepine, lisdexamfetamine, lorcaserin, methamphetamine, mirtazapine, pioglitazone, progesterone, guanfacine, levodopa, nefazodone presented promising anti-craving effects. Unfortunately, the highly tested medications were not successful in most of the trials, as follows: propranolol in the short term; amantadine, aripiprazole, bromocriptine, citicoline, ketamine, modafinil, olanzapine, topiramate in the long term. The remaining 52 medications had no positive anti-craving outcomes. Limitations: Our review was limited by high heterogeneity of craving assessments across the studies and by a great range of pharmacotherapies. Further, the majority of the studies considered abstinence and retention in treatment as the main outcomes, whereas craving was a secondary outcome and some of the studies evaluated patients with cocaine use disorder with comorbidities such as opioid or alcohol use disorder, schizophrenia, bipolar disorder or attention deficit hyperactivity. Lastly, most of the studies also included non-pharmacological treatments, such as counseling or psychotherapy Conclusions: There is a direct association between craving and cocaine use, underscoring craving as an important treatment target for promoting abstinence among persons with cocaine use disorder. Clonidine, fenfluramine and m-CPP showed to be promising medications for cocaine craving in the short-term treatment, and amphetamine, biperiden, carbamazepine, lisdexamfetamine, lorcaserin, methamphetamine, mirtazapine, pioglitazone, progesterone, guanfacine, levodopa, nefazodone in the long-term treatment.

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Comparison of Desipramine or Carbamazepine to Placebo for Crack Cocaine‐Dependent Patients

Cited by 28 publications

References 27 publications

Discriminative-stimulus, self-reported, performance, and cardiovascular effects of atomoxetine in methylphenidate-trained humans.

Discriminative-stimulus, self-reported, performance, and cardiovascular effects of atomoxetine in methylphenidate-trained humans.

Self‐administration of cocaine, cannabis and heroin in the human laboratory: benefits and pitfalls

Pharmacological Treatments for Cocaine Craving: What Is the Way Forward? A Systematic Review

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