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Cited by 122Substance Abuse Treatment and OutcomesSchizophrenia research and treatmentNeurotransmitter Receptor Influence on Behavior

Antipsychotic medications for cocaine dependence

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Indave, Blanca I, Minozzi, Silvia, Pani, Pier Paolo, Amato, Laura·2016·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006306.pub3PMC PMC8750745
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Abstract

BACKGROUND: Cocaine dependence is a public health problem characterised by recidivism and a host of medical and psychosocial complications. Cocaine dependence remains a disorder for which no pharmacological treatment of proven efficacy exists. OBJECTIVES: To evaluate the efficacy and the acceptability of antipsychotic medications for cocaine dependence. SEARCH METHODS: This review is an update of a previous Cochrane review published in 2007. We searched up to 15 July 2015 in Cochrane Drugs and Alcohol Group Specialised Register (searched in CRSLive); the Cochrane Library (including the Cochrane Central Register of Controlled Trials (CENTRAL); the Database of Abstracts of Reviews of Effects (DARE)); PubMed; EMBASE; CINAHL and Web of Science. All searches included non-English language literature. SELECTION CRITERIA: All randomised controlled trials and controlled clinical trials with focus on the use of any antipsychotic medication for the treatment of cocaine dependence. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 14 studies (719 participants). The antipsychotic drugs studied were risperidone, olanzapine, quetiapine, lamotrigine, aripiprazol, haloperidol and reserpine. Comparing any antipsychotic drugs versus placebo, we found that antipsychotics reduced dropout: eight studies, 397 participants, risk ratio (RR) 0.75 (95% confidence interval (CI) 0.57 to 0.97), moderate quality of evidence. We found no significant differences for any of the other primary outcomes considered: number of participants using cocaine during the treatment, two studies, 91 participants: RR 1.02 (95% CI 0.65 to 1.62); continuous abstinence, three studies, 139 participants: RR 1.30 (95% CI 0.73 to 2.32); side effects, six studies, 291 participants: RR 1.01 (95% CI 0.93 to 1.10); and craving, four studies, 240 participants: RR 0.13 (-1.08 to 1.35). For all of these comparisons we rated the quality of evidence as low.Comparisons of single drug versus placebo or versus another drug are conducted in few trials with small sample sizes, limiting the reliability of the results. Among these comparisons, only quetiapine seemed to outperform placebo in reducing cocaine use, measured by grams per week: mean difference (MD) -0.54 (95% CI -0.92 to -0.16), by US dollars spent per week: MD -53.80 (95% CI -97.85 to -9.75), and by craving: MD -1.23 (95% CI -2.19 to -0.27), but results came from one study with 60 participants.The major limitations of the studies were the high risk of attrition bias (40% of the included studies) and low quality of reporting, mainly for the risk of selection bias, performance and detection bias, that we rated as being at unclear risk for 75% to 80% of the studies. Furthermore, most of the included studies did not report results on important outcomes such as side effects, or use of cocaine during treatment and craving, which prevented the possibility of including them in statistical synthesis. AUTHORS' CONCLUSIONS: At present, there is no evidence supporting the clinical use of antipsychotic medications in the treatment of cocaine dependence, although results come from only 14 trials, with small sample sizes and moderate to low quality of evidence.

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  • Mirtazapine may help treat anxiety.

    “It is FDA-approved to treat depression, may also help treat anxiety and improve sleep quality, and has no known potential for misuse.128”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [128]

    Our copy’s ‘(03) Olanzapine versus placebo’ section reports no significant difference in anxiety scores for olanzapine, not mirtazapine. Searches for ‘mirtazapine’ and ‘anxiety and improve sleep quality’ found no passage addressing whether mirtazapine may help treat anxiety. (LLM, conf=0.76)

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  • Mirtazapine is FDA-approved to treat depression.

    “It is FDA-approved to treat depression, may also help treat anxiety and improve sleep quality, and has no known potential for misuse.128”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [128]

    The cited review’s sections on antipsychotics and depression outcomes discuss drugs such as quetiapine, not mirtazapine’s regulatory approval. Searches for “mirtazapine” and “FDA approved” found no passage in our copy addressing whether mirtazapine is FDA-approved to treat depression. (LLM, conf=0.75)

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  • Mirtazapine may improve sleep quality.

    “It is FDA-approved to treat depression, may also help treat anxiety and improve sleep quality, and has no known potential for misuse.128”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [128]

    The Main results section lists the drugs studied and does not include mirtazapine. Searches for mirtazapine with sleep quality and insomnia returned no relevant passage; our copy does not address whether it improves sleep quality. No page number is available for these passages. (LLM, conf=0.78)

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  • Mirtazapine has no known potential for misuse.

    “It is FDA-approved to treat depression, may also help treat anxiety and improve sleep quality, and has no known potential for misuse.128”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [128]

    The Main results section lists the drugs studied but does not include mirtazapine. Searches for mirtazapine and misuse or abuse potential found no passage addressing whether mirtazapine has potential for misuse. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Authors
Indave, B. I., Minozzi, S., Pani, P. P., & Amato, L.
Affiliations
  • European Monitoring Centre for Drugs and Drug Addiction (PT)
  • Lazio Regional Health Service; Department of Epidemiology; Via Cristoforo Colombo, 112 Rome Italy 00154
  • Health District 8 (ASL 8) Cagliari; Social-Health Division; Via Romagna 17 Cagliari Sardinia Italy 09128
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2016-03-19
Volume
2016
Issue
6
Pages
CD006306-CD006306
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd006306.pub3
PMC
PMC8750745
OpenAlex
W1507790507
Cited by
122
References
102
Citations by year
2024: 9 · 2023: 4 · 2022: 9 · 2021: 4 · 2020: 14 · 2019: 13 · 2018: 5 · 2017: 9 · 2016: 2 · 2015: 13 · 2014: 6 · 2013: 8 · 2012: 7
FWCI
1.31
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
cocaine dependence, antipsychotic drugs, pharmacotherapy, risperidone, olanzapine, quetiapine, lamotrigine, aripiprazole, haloperidol, reserpine, cocaine abstinence, treatment discontinuation, craving, adverse effects, treatment acceptability, relapse, substance use disorders, placebo comparison, drug comparison, quality of evidence
MeSH terms
Aripiprazole, Quetiapine Fumarate, Olanzapine, Lamotrigine, Benzodiazepines, Haloperidol, Humans, Patient Dropouts, Reserpine, Antipsychotic Agents, Triazines, Randomized Controlled Trials as Topic, Risperidone, Cocaine-Related Disorders

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