Antipsychotic Drugs in Cocaine Use Disorder

© 2017 Elsevier Inc. All rights reserved. Cocaine use disorder is a major public health concern due to its health-related consequences. Therapy includes both nonpharmacological (cognitive-behavioral therapy and others) and pharmacological treatments. Medicines are used off-label and include some antidepressants, dopamine agonists, psychostimulants, anticonvulsants, and antipsychotics. Antipsychotics are mainly antagonist of dopamine D2 receptors but some have antagonist action on serotonin, alpha adrenergic, muscarinic, and histamine receptors. The most frequent side effects of antipsychotics are sedation and extrapyramidal effects (dystonia), hyperprolactinemia, weight gain, intolerance to glucose, dry mouth, and electrocardiogram changes. Atypical antipsychotics have been used for the treatment of cocaine dependence/addiction. Meta-analysis of randomized controlled trials comparing antipsychotic versus placebo showed no differences between treatments for the more relevant outcomes related to efficacy and showed more undesirable effects due to intolerance. The evidence based on the meta-analysis of randomized clinical trials does not justify the use of antipsychotics for cocaine dependence.