Table 2.
Summary of literature on clinical management of cocaine withdrawal symptoms
| Authors | Year | Journal | Design | N | Treatment | Timeframe | Withdrawal-related findings |
|---|---|---|---|---|---|---|---|
| Arndt, I.O. et al. | 1992 | Archives of General Psychiatry | Randomized placebo-controlled trial | 59 | Desipramine hydrochloride (50 mg/d, increasing 50mg every 2–4 days to 250–300mg/d); matching placebo | 12-week medication phase, followed by 1, 3, and 6 post-treatment recontact | Significantly greater improvements in psychiatric status compared to placebo. |
| Campbell, J. et al. | 2003 | American Journal on Addictions | Randomized placebo-controlled trial | 57 | Desipramine (50 mg/d increasing to 200 mg/d); carbamazepine (initiated at 200 mg/d increasing to 800 mg/d); matching placebo | 8 weeks outpatient following randomization | Desipramine showed significantly greater reductions in depressive symptoms and irritability compared other groups. |
| Dackis et al. | 2005 | Neuropsychopharmacology | Randomized placebo-controlled trial | 62 | Modafinil (400 mg/d); matching placebo; all with CBT | 8 weeks following randomization | Significantly greater abstinence compared to placebo, but no significant differences in craving or withdrawal. |
| Dackis et al. | 2012 | Journal of Substance Abuse Treatment | Randomized placebo-controlled trial | 210 | Modafinil (0 mg/day, 200 mg/day, or 400 mg/day) for 8 weeks; all with CBT | 8 weeks following randomization; 3 months post-treatment follow-up | No significant differences in cocaine use, craving, withdrawal, retention, or abstinence |
| Gawin, F.H., et al. | 1989 | Archives of General Psychiatry | Randomized placebo-controlled trial | 72 | Desipramine hydrochloride (2.5 mg/kg); active placebo (atropine 0.1 mg) | 6 weeks outpatient following randomization | Significantly greater reductions in craving compared to lithium and placebo. |
| Johnson, B.A. et al. | 2013 | JAMA Psychiatry | Randomized placebo-controlled trial | 142 | Topiramate (50 mg/d increasing to 300 mg/d in weeks 6–12); matching placebo; all with cognitive behavioral therapy (CBT); | 12 weeks following randomization | Significantly greater reductions in craving, symptoms of cocaine dependence, and cocaine use (confirmed by urine tests) compared to placebo. |
| Kampman , K.M. et al. | 2006 | Drug and Alcohol Dependence | Randomized placebo-controlled trial | 199 | Amantadine (300 mg/day); propranolol (100 mg/day); amantadine (300 mg/d) + propranolol (100 mg/d); matching placebo | 10 weeks with 2-week baseline phase and 8-week treatment phase | No significant difference in retention or abstinence compared to placebo among those entering the study with severe cocaine withdrawal; changes in withdrawal symptoms not among the reported outcomes. |
| Kampman, K.M. et al. | 2013 | Drug and Alcohol Dependence | Randomized placebo-controlled trial | 170 | Topiramate (300 mg/d); placebo; all with psychotherapy | 13 weeks; 3-day abstinence prior to treatment | No significant differences in reducing craving or cocaine use. |
| McDowell, D. et al. | 2005 | Drug and Alcohol Dependence | Randomized placebo-controlled trial | 111 | Desipramine (50 mg/d increased by 50 mg every 4 days up to 300 mg/d); matching placebo; all with psychosocial treatment | 12 weeks after 1-week single blind placebo phase and randomization | Significantly greater improvements in depressive symptoms compared to placebo. |
| Nuijten, M. et al. | 2014 | Drug and Alcohol Dependence | Randomized controlled trial | 74 | Topiramate (200 mg/d) + CBT; CBT only | 12 weeks after randomization | No significant differences in improving craving, physical health, or mental health. |
| Umbricht et al. | 2014 | Drug and Alcohol Dependence | Randomized placebo-controlled trial | 171 | 2x2 factorial design of topiramate (ascending by 25 mg to 300 mg/d by week 13, tapered weeks 21–23) vs. placebo, plus contingency management vs. non-contingent rewards; all participants in methadone maintenance | 31 weeks total, with treatment from weeks 5–23 following methadone induction and placebo lead-in | No significant differences in reduced craving, depression, or anxiety. |
| Terraneo et al. | 2016 | European Neuropsychopharmacology | Randomized controlled trial | 32 | Repetitive transcranial magnetic stimulation (15 Hz, left DLPFC) | 29 days following randomization, 63-day follow-up post-treatment | Significantly greater reductions in craving and higher number of negative urine tests compared to control. |
Note: Articles listed are stimulant use reduction trials reporting withdrawal symptoms.