eMedicine Specialties > Neurology > Neurotoxicology

Cocaine: Treatment & Medication

Author: Pinky Agarwal, MD, Clinical Assistant Professor, Department of Neurology, University of Washington; Attending Neurologist, Booth Gardner Parkinson's Care Center
Coauthor(s): Souvik Sen, MD, MS, FAHA,, Associate Professor of Neurology, Founding Director of UNC Hospital Stroke Center, Director of Neurovascular Residency, Department of Neurology, University of North Carolina at Chapel Hill
Contributor Information and Disclosures

Updated: Aug 26, 2009

Treatment

Medical Care

  • Acute intoxication requires hospitalization for detoxification and management of acute neurovascular complications.
  • For long-term management, drug-dependence programs can be effective in decreasing drug use by behavioral interventions. Cognitive behavioral therapy can be effective in decreasing craving for the drug.
  • No pharmacotherapies have been approved for cocaine addiction; but some drugs have been tested with promising results.
    • Disulfiram, amantadine, tiagabine, topiramate, and baclofen are some drugs that have been reported to be of possible benefit in cocaine addiction.
    • Counseling plus buprenorphine-naloxone maintenance therapy has been reported to be successful for opioid dependence.
    • A recent double-blinded, placebo-controlled trial of modafinil for cocaine dependence showed that modafinil improved clinical outcomes when combined with psychosocial treatment for cocaine dependence.
    • The psychotropic analgesic nitrous oxide has been reported in one blinded trial to be effective for the treatment of acute cocaine withdrawal.
    • In one trial, both quetiapine and risperidone reduced drug cravings from cocaine.10
    • A recent randomized, double-blind, placebo controlled trial comparing treatment with bupropion and placebo in combination with standard cognitive behavioral therapy found no statistical difference in bupropion relative to placebo.11
  • Patients require follow-up for neurological complications.
  • Use of beta-blockers in cocaine-induced chest pain is a controversial issue.12 The American Heart Association (AHA) published a scientific statement on management of cocaine-associated chest pain and myocardial infarction in 2008 which recommends avoiding use of beta blockers which may exacerbate vasospasm.13

More on Cocaine

Overview: Cocaine
Differential Diagnoses & Workup: Cocaine
Treatment & Medication: Cocaine
Follow-up: Cocaine
References
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References

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Further Reading

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Keywords

crack, street drugs, substance-related disorder, substance abuse, drug abuse, benzoylmethylecgonine, blow, coke, snow, toot, nose candy, freebase

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Contributor Information and Disclosures

Author

Pinky Agarwal, MD, Clinical Assistant Professor, Department of Neurology, University of Washington; Attending Neurologist, Booth Gardner Parkinson's Care Center
Pinky Agarwal, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, Association of Clinical Research Professionals, and Movement Disorders Society
Disclosure: Nothing to disclose.

Coauthor(s)

Souvik Sen, MD, MS, FAHA,, Associate Professor of Neurology, Founding Director of UNC Hospital Stroke Center, Director of Neurovascular Residency, Department of Neurology, University of North Carolina at Chapel Hill
Souvik Sen, MD, MS, FAHA, is a member of the following medical societies: American Academy of Neurology, American Heart Association, and Association for Patient Oriented Research
Disclosure: Nothing to disclose.

Medical Editor

Edward L Hogan, MD, Professor, Department of Neurology, Medical College of Georgia; Emeritus Professor and Chair, Department of Neurology, Medical University of South Carolina
Edward L Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Neurological Association, American Society for Biochemistry and Molecular Biology, Phi Beta Kappa, Sigma Xi, Society for Neuroscience, and Southern Clinical Neurological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, Professor, Department of Internal Medicine, Section of Neurology, Dartmouth Medical School; Chief, Neurology Service, White River Junction Veterans Medical Center
Stephen A Berman, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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