A systematic review and meta-analysis to evaluate the efficacy of antipsychotic drugs in subjects with cocaine dependence is presented. Twelve randomized, double-blind, placebo-controlled clinical trials involving 681 patients were included. Five outcome measures were evaluated: number of dropouts, cocaine use assessed by means of urine benzoylecgonine tests, self-reported cocaine use, craving and Addiction Severity Index. On average, 48% of the enrolled participants were lost to follow-up. In comparison to placebo, antipsychotics did not significantly reduce cocaine use (WMD = 0.01, 95%CI = - 0.12 to 0.13) or improve retention in treatment (RR 0.91, 95%CI = 0.82-1.02). Risperidone reduced slightly dropouts in comparison to placebo (RR = 0.87; 95%CI = 0.79-0.97). To date there is insufficient evidence to justify the use of antipsychotic drugs for cocaine dependence. © 2013 Elsevier Inc.