April 2001

From University of Pennsylvania Medical Center

Blood medicine may ease cocaine withdrawal

Philadelphia, PA –A medication long used to treat high blood pressure may ease severe withdrawal symptoms during the early stages of treatment for cocaine addiction, offering new hope for patients unable to wean themselves off cocaine through traditional, psychotherapeutic counseling.

Scientists at the University of Pennsylvania School of Medicine and the Department of Veterans Affairs Medical Center in Philadelphia believe the results of a recent study show that the medication propranolol may provide a bridge for cocaine-dependent patients struggling to get past the first critical weeks of recovery and stay in treatment.

The results of the propranolol study is published in the April 2001 issue of Drug and Alcohol Dependence, a peer-reviewed journal.

“The drop out rate in cocaine treatment programs is very high,” said Penn’s Kyle Kampman, M.D., the study’s lead researcher. “We found that when patients who experienced severe withdrawal symptoms were given propranolol, they tended to stay in treatment longer and use less cocaine.”

Propranolol works to block the anxiety-producing effects of adrenaline. Those suffering severe withdrawal symptoms are often more sensitive to adrenaline, which can heighten anxiety in stressful situations and undermine treatment, Kampman said.

The findings emerged in an eight-week, double blind, placebo-controlled trial in which propranolol was administered to 108 people addicted to cocaine. Participants in the study, conducted in the fall of 1999, received counseling twice weekly along with regular doses of propranolol or a placebo. Scientists concluded that subjects with more severe cocaine withdrawal symptoms responded better to propranolol in comparison to those given the placebo.

“The patients who come in with severe withdrawal symptoms generally are heavier users and are tougher to treat,” said Kampman. “We know from previous studies that they are more likely to drop out of treatment programs and are unable to detoxify. Propranolol may be one way to keep them in treatment longer.”

The propranolol investigation was funded through a grant from the National Institute on Drug Abuse (NIDA).

The study echoes an earlier investigation led by Kampman into amantadine, a medication used to treat Parkinson’s disease. In that study, researchers found that the medication may reduce cocaine cravings in patients experiencing significant withdrawal symptoms.

In the amantadine study, conducted in 1994, 61 cocaine dependent outpatients participated in a four-week, double blind, placebo controlled study in which participants received 100 mg of the medication three times daily. Results indicated that the craving for cocaine in those patients who suffered the most intense withdrawal symptoms diminished when amantadine was administered.

Amantadine is thought to raise dopamine levels in the brain, reducing the craving for cocaine. The results of the investigation into amantadine were reported in the American Journal of Psychiatry in December 2000. The study was peer-reviewed and supported through a NIDA grant.

Kampman said a third study exploring the potential benefits of using propranolol and amantadine in combination or with other treatment protocols is underway at Penn and the Department of Veterans Affairs Medical Center in Philadelphia.












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