Dopamine agonists for the treatment of cocaine dependence

Amato L, Minozzi S, Pani PP, Solimini R, Vecchi S, Zuccaro P, Davoli M

Published Online:

December 7, 2011

A pharmacological agent with proven efficacy does not exist for treatment of cocaine dependence. Cocaine is an alkaloid derived from the erythroxylon coca leaf that is used as powder for intranasal or intravenous use or as crack, a free-base form which is smoked. Cocaine dependence is a major public health problem because its use can be associated with medical and psychosocial complications including the spread of infectious diseases (such as AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. This review looked at the evidence on the efficacy and acceptability of dopamine agonists as a treatment, alone or in combination with any psychosocial intervention.

Abstract (click to read)

Background:

Cocaine dependence is a disorder for which no pharmacological treatment of proven efficacy exists, advances in the neurobiology could guide future medication development

Objectives:

To investigate the efficacy and acceptability of dopamine agonists alone or in combination with any psychosocial intervention for the treatment of cocaine abuse and dependence

Search strategy:

We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL, PsycINFO in June 2011 and researchers for unpublished trials

Selection criteria:

Randomised and controlled clinical trials comparing dopamine agonists alone or associated with psychosocial intervention with placebo, no treatment, other pharmacological interventions

Data collection and analysis:

Two authors independently assessed trial quality and extracted data

Main results:

Twenty three studies, 2066 participants, met the inclusion criteria. Comparing any dopamine agonist versus placebo, placebo performed better for severity of dependence, four studies, 232 participants, SMD 0.43 (95% CI 0.15 to 0.71), depression, five studies, 322 participants, SMD 0.42 (95% CI 0.19 to 0.65) and abstinent at follow up RR 0.57 (95% CI 0.35 to 0.93). No statistically significant different for the other outcomes considered. Comparing amantadine versus placebo, results never gain the statistical significance, but there is a trend in favour of amantadine for dropouts and depression. Results on adverse events and depression, were in favour of placebo although the difference do not reach the statistical significance. Comparing bromocriptine and Ldopa/Carbidopa versus placebo, results never reached statistical significance. Comparing amantadine versus antidepressants, antidepressants performed better for abstinence. The other two outcomes considered did not show statistically significant differences although dropouts and adverse events tended to be more common in the antidepressant group.

The quality of evidence, assessed according to GRADE method, may be judged as moderate for the efficacy of any dopamine agonist versus placebo and as moderate to high for amantadine versus placebo and versus antidepressants.

Authors' conclusions:

Current evidence from randomised controlled trials does not support the use of dopamine agonists for treating cocaine dependence. This absence of evidence may leave to clinicians the alternative of balancing the possible benefits against the potential adverse effects of the treatment.
Even the potential benefit of combining a dopamine agonist with a more potent psychosocial intervention which was suggested by the previous Cochrane review (Soares 2003), is not supported by the results of this updated review.

This record should be cited as:

Amato L, Minozzi S, Pani PP, Solimini R, Vecchi S, Zuccaro P, Davoli M. Dopamine agonists for the treatment of cocaine dependence. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD003352. DOI: 10.1002/14651858.CD003352.pub3

Assessed as up to date:

October 12, 2011

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Primary Review Group:

Drugs and Alcohol Group

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Dopamine agonists for the treatment of cocaine dependence

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