Vocci Frank J, Elkashef Ahmed
Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-9551, USA.
Curr Opin Psychiatry. 2005 May;18(3):265-70. doi: 10.1097/01.yco.0000165596.98552.02.
This review examines progress being made in the treatment of cocaine abuse and dependence, with a particular focus on pharmacotherapies. Medications with apparently very different mechanisms of action have been reported to reduce cocaine use in controlled clinical trials in outpatient settings. This review will summarize the latest findings in this area.
Of all the medications tested to date, disulfiram has demonstrated the most consistent effect to reduce cocaine use. Several medications have been reported to reduce cocaine use in double-blind, placebo-controlled clinical trials, namely baclofen, modafinil, tiagabine, and topiramate. All pharmacotherapy trials in cocaine-dependent patients include a behavioral therapy that is common to all participants. Consequently, these pharmacotherapy trials can be considered to evaluate whether the medication is adding to the effect of the behavioral therapy.
Confirmatory clinical studies are necessary to replicate the initial efficacy findings for baclofen, modafinil, tiagabine, and topiramate. More research is needed in both cocaine and cocaine-alcohol dependent populations. Once confirmatory studies have been carried out, testing of rational medication combinations with different behavioral therapies is an obvious next step to increase the ability to manage cocaine dependence.
本综述探讨可卡因滥用和依赖治疗方面取得的进展，特别关注药物治疗。据报道，作用机制明显不同的药物在门诊环境的对照临床试验中可减少可卡因使用。本综述将总结该领域的最新发现。
在迄今为止测试的所有药物中，双硫仑已证明在减少可卡因使用方面效果最为一致。据报道，几种药物在双盲、安慰剂对照临床试验中可减少可卡因使用，即巴氯芬、莫达非尼、噻加宾和托吡酯。所有针对可卡因依赖患者的药物治疗试验都包括一种所有参与者都通用的行为疗法。因此，这些药物治疗试验可被视为评估药物是否增强了行为疗法的效果。
有必要进行确证性临床研究，以重现巴氯芬、莫达非尼、噻加宾和托吡酯的初步疗效发现。在可卡因依赖人群和可卡因 - 酒精双重依赖人群中都需要更多研究。一旦完成确证性研究，测试合理的药物组合与不同行为疗法显然是提高管理可卡因依赖能力的下一步。
