Neurologic Effects of Cocaine Treatment & Management

  • Author: Pinky Agarwal, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA   more...
 
Updated: Mar 8, 2011
 

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]
  • Martell et al conducted a phase IIb randomized, double-blind, placebo-controlled trial to evaluate the immunogenicity, safety, and efficacy of a cocaine vaccine in cocaine-dependent and opioid-dependent individuals. Of the 115 patients recruited, 94 (82%) completed the trial. Participants were administered 5 vaccinations with placebo or succinylnorcocaine over 12 weeks. Within the vaccine group, those with serum IgG anticocaine antibody levels ≥ 43 mcg/mL had significantly more cocaine-free urine samples than those with serum levels < 43 mcg/mL and those who received placebo. Reduction of cocaine use by 50% was significantly greater if a high IgG level was achieved (53% of participants) compared with a low IgG level (23% of participants) (P =0.048).[14]
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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, Kirkland, WA

Pinky Agarwal, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Movement Disorders Society

Disclosure: Nothing to disclose.

Coauthor(s)

Souvik Sen, MD, MPH, MS, FAHA  Professor and Chair, Department of Neurology, University of South Carolina School of Medicine

Souvik Sen, MD, MPH, MS, FAHA is a member of the following medical societies: American Academy of Neurology, American Heart Association, and Association for Patient Oriented Research

Disclosure: NINDS Grant/research funds Research project; BMS/Sanofi Aventis Honoraria Speaking and teaching; Boehringer Ingelheim Honoraria Speaking and teaching

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

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: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA 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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