Quetiapine for Cocaine Use and Cravings
Condition: Cocaine-Related Disorders; Substance-Related Disorders
MeSH terms: Substance-Related Disorders; Cocaine-Related Disorders
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study was to collect pilot data on whether quetiapine may be effective in
      the reduction of cocaine use and cravings in cocaine dependent individuals.
    

Detailed description: 
      Dopaminergic and serotonergic neurotransmitter systems are involved in cocaine use and
      cravings. Atypical antipsychotics act on these neurotransmitter systems, and therefore, may
      be beneficial in the treatment of cocaine addiction. This open label study assessed the
      efficacy of quetiapine for the treatment of cocaine use and craving in non-psychotic, cocaine
      dependent participants over 6 weeks of treatment. The primary outcome measures included
      self-report of cocaine use and self-report of cocaine cravings. This study also evaluated
      whether the severity of addiction predicts quetiapine efficacy.

      Males and females, ages 18 - 65, with a DSM IV diagnosis of cocaine dependence were recruited
      for an open label trial of quetiapine dosed at 300-600 mg/day, with a target dose of 600
      mg/day. Subjects were followed at weekly study visits to monitor general psychiatric and
      physical status, medication compliance, efficacy, and adverse events. Study participation
      included psychiatric and medical examinations, an electrocardiogram, an eye exam, laboratory
      tests, urine drug screens, electrocardiograms, and psychiatric and substance abuse
      interviews.

      Twenty-three males were initiated on quetiapine treatment, the following results include the
      first twenty-two study completers. Twenty-two males (36-56 years) diagnosed with cocaine
      dependence without a psychotic disorder, were initiated on a six-week, open-label trial of
      quetiapine, 300-600 mg/day (QHS). Five participants discontinued prior to completing the
      first week of treatment, and 14 of 22 subjects completed the study. The mean dose of
      quetiapine was 429 mg/day. An intent-to-treat analysis found a significant decrease in
      cravings on the Brief Substance Craving Scale after six weeks (p < 0.01, Cohen's d = 1.23;
      repeated measures mixed effects random regression). Cocaine use, addiction severity, and
      psychopathology also decreased numerically, but not statistically, from baseline to end of
      study. Adverse effects were generally mild. Addiction severity did not predict quetiapine
      efficacy. Four subjects withdrew due to sedation; 2 were discontinued by the investigators,
      and 2 were lost to follow up. Study completers experienced a statistically significant mean
      weight gain of approximately 4.60 (95% CI, -6.05 - 3.17 kg)(mean baseline weight 86.9 (SD
      18.38) kg).

      Quetiapine treatment appears to have improved cocaine dependence, specifically cocaine
      cravings, in non-psychotic individuals. The observed weight change may reflect both weight
      gain associated with cocaine dependence and medication side effect. Controlled research is
      warranted to better define the potential role for quetiapine in the treatment of cocaine
      dependence.
    

Intervention name(s): quetiapine
Intervention type(s): Drug
Intervention MeSH terms: Quetiapine Fumarate
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: cocaine; drug; substance; abuse; addiction; dependence; quetiapine; antipsychotic; treatment