Pharmacotherapeutic interventions for cocaine abuse: present practices and future directions

The therapeutic management of the cocaine addict deals with a wide range of physical and psychological withdrawal symptoms, including a sometimes overwhelming craving for cocaine. Many medications have been used in the treatment of cocaine withdrawal and dependence, using as a rationale, known pharmacologic effects of cocaine on neurotransmitters. Animal observations related to dopamine depletion, receptor supersensitivity, cocaine-induced kindling, and serotonin depletion have all generated pharmacotherapeutic interventions for cocaine abuse. An extensive review of the use of these agents is presented. Pharmacotherapeutic strategies in dealing with the methadone-maintained cocaine abuser are considered. Future areas of interest and limitations of pharmacotherapy in dealing with cocaine abuse are discussed.