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Anticonvulsants for cocaine dependence

Overview of attention for article published in this source, April 2015
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Title
Anticonvulsants for cocaine dependence
Published by
John Wiley & Sons, Ltd, April 2015
DOI 10.1002/14651858.cd006754.pub4
Pubmed ID
Authors

Minozzi, Silvia, Cinquini, Michela, Amato, Laura, Davoli, Marina, Farrell, Michael F, Pani, Pier Paolo, Vecchi, Simona

Abstract

Cocaine dependence is a major public health problem that is characterised by recidivism and a host of medical and psychosocial complications. Although effective pharmacotherapy is available for alcohol and heroin dependence, none is currently available for cocaine dependence, despite two decades of clinical trials primarily involving antidepressant, anticonvulsivant and dopaminergic medications. Extensive consideration has been given to optimal pharmacological approaches to the treatment of individuals with cocaine dependence, and both dopamine antagonists and agonists have been considered. Anticonvulsants have been candidates for use in the treatment of addiction based on the hypothesis that seizure kindling-like mechanisms contribute to addiction. To evaluate the efficacy and safety of anticonvulsants for individuals with cocaine dependence. We searched the Cochrane Drugs and Alcohol Group Trials Register (June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 6), MEDLINE (1966 to June 2014), EMBASE (1988 to June 2014), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to June 2014), Web of Science (1991 to June 2014) and the reference lists of eligible articles. All randomised controlled trials and controlled clinical trials that focus on the use of anticonvulsant medications to treat individuals with cocaine dependence. We used the standard methodological procedures expected by The Cochrane Collaboration. We included a total of 20 studies with 2068 participants. We studied the anticonvulsant drugs carbamazepine, gabapentin, lamotrigine, phenytoin, tiagabine, topiramate and vigabatrin. All studies compared anticonvulsants versus placebo. Only one study had one arm by which the anticonvulsant was compared with the antidepressant desipramine. Upon comparison of anticonvulsant versus placebo, we found no significant differences for any of the efficacy and safety measures. Dropouts: risk ratio (RR) 0.95, 95% confidence interval (CI) 0.86 to 1.05, 17 studies, 20 arms, 1695 participants, moderate quality of evidence. Use of cocaine: RR 0.92, 95% CI 0.84 to 1.02, nine studies, 11 arms, 867 participants, moderate quality of evidence; side effects: RR 1.39, 95% CI 1.01 to 1.90, eight studies, 775 participants; craving: standardised mean difference (SMD) -0.25, 95% CI -0.59 to 0.09, seven studies, eight arms, 428 participants, low quality of evidence. Although caution is needed when results from a limited number of small clinical trials are assessed, no current evidence supports the clinical use of anticonvulsant medications in the treatment of patients with cocaine dependence. Although the findings of new trials will improve the quality of study results, especially in relation to specific medications, anticonvulsants as a category cannot be considered first-, second- or third-line treatment for cocaine dependence.

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Mendeley readers

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Geographical breakdown

Country Count As %
Spain 1 <1%
United Kingdom 1 <1%
Argentina 1 <1%
Canada 1 <1%
Unknown 160 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 37 23%
Unspecified 29 18%
Student > Ph. D. Student 21 13%
Researcher 21 13%
Student > Bachelor 14 9%
Other 42 26%
Readers by discipline Count As %
Medicine and Dentistry 58 35%
Unspecified 39 24%
Psychology 18 11%
Nursing and Health Professions 15 9%
Social Sciences 9 5%
Other 25 15%