Clinical potential of methylphenidate in the treatment of cocaine addiction: a review of the current evidence

Figures & data

Table 1 Overview of case reports and clinical trials addressing methylphenidate as a treatment for cocaine dependence

Author (year)	Participants	Intervention	Outcome measures	Findings
Case reports
Khantzian (1983)^Citation23	One female outpatient with childhood history indicative of ADHD	MPH starting dose 15 mg tid	Urinalysis, self-reports	MPH effective in reducing cocaine use
Khantzian et al (1984)^Citation108	Three patients (one female, two male), one male with ADHD	MPH starting dose 15 mg tid or 5 mg qid, max 70 mg/day	Urinalysis, self-reports	MPH effective in reducing cocaine use
Imbert et al (2014)^Citation109	One male outpatient with adult ADHD	SR MPH starting dose 18 mg/day, increased to 54 mg/day	Urinalysis, clinical examination, CCQ-Brief	MPH effective in reducing cocaine use
Mariani et al (2014)^Citation110	One male outpatient	SR MPH starting dose 36 mg/day, decreased to 27 mg/day	Urinalysis, self-reported cocaine use	MPH effective in reducing cocaine use
Gawin et al (1985)^Citation111	Five male patients without ADHD	MPH starting dose 20 or 40 mg/day, max 100 mg/day	Self-reported cocaine craving and use	MPH not effective, increased cocaine use and craving
Open-label trials
Levin et al (1998)^Citation112	12 outpatients with adult ADHD	SR MPH doses from 20 to 40 mg bid	Urinalysis (tiw), ASI, side effects checklist, cocaine- craving questionnaire	MPH effective in reducing cocaine use; eight patients completed the study
Castaneda et al (1999)^Citation113	19 private patients with adult ADHD (17 males)	Fluoxetine 20 mg# Bupropion 100 mg Pemoline 37.5 mg SR MPH 20 mg Dextroamphetamine 10 mg Methamphetamine 15 mg	Urinalysis (qw or biw)	LA stimulants alone or in combination with fluoxetine or bupropion most effective
Somoza et al (2004)^Citation114	41 outpatients with adult ADHD	IR MPH starting dose 20 mg/day, max 20 mg tid	Urinalysis (tiw), CGI, ASI, Substance Use Questionnaire, BSCS, CCQ-GEN, vital signs and adverse events, retention in treatment	MPH effective in compliant patients; 70% completed the study
Double-blind, randomized, placebo-controlled studies
Levin et al (2007)^Citation118	106 outpatients with adult ADHD (83% males)	1. I R MPH starting dose 10 mg/day, SR MPH max 60 mg/day (40 mg am, 20 mg pm); n=53 2. Placebo; n=53	Urinalysis (tiw), self-reports, retention in treatment	MPH reduced likelihood of cocaine use over time; 23 patients of group 1 and 24 patients of group 2 completed the study
Grabowski et al (1997)^Citation59	49 outpatients without ADHD	1. MPH 45 mg/day (5 mg IR and 20 mg SR MPH am, 20 mg SR pm); n=25 2. Placebo; n=24	Urinalysis (biw), ASI, SEQ, retention in treatment	No advantage of MPH over placebo in reducing cocaine use; 48% of group 1 and 42% of group 2 completed the study
Schubiner et al (2002)^Citation61	48 outpatients with adult ADHD (43 males)	1. MPH 30 mg/tid; n=24 2. Placebo; n=24	Urinalysis (tiw), ASI, CCQ-GEN, self-reports, side effects checklist, retention in treatment	No advantage of MPH over placebo in reducing cocaine use; 45% of group 1 and 58% of group 2 completed the study
Levin et al (2006)^Citation117	98 methadone- maintained outpatients with adult ADHD (57% males)	1. IR MPH starting dose 5 mg/bid, SR MPH max 40 mg/bid; n=32 2. SR bupropion max 400 mg/day; n=33 3. Placebo; n=33	Urinalysis (tiw), self-reports, retention in treatment	No advantage of active medications over placebo in reducing cocaine use; 21 patients of group 1, 23 patients of group 2, and 25 patients of group 3 completed the study
Dürsteler- MacFarland et al (2013)^Citation31	62 diacetylmorphine- maintained outpatients (40 males)	1. IR MPH 30 mg bid + CBGT; n=15 2. IR MPH 30 mg bid + treatment as usual; n=15 3. Placebo + CBGT; n=17 4. Placebo + treatment as usual; n=15	Urinalysis (tiw), self-reports, adverse effects, retention in treatment	No advantage of MPH over placebo in reducing cocaine use, no additive effects of MPH and CBT; 71% completed the study with no between-group differences

Note:

# Medications were introduced in an order inversely related to their expected degree of stimulant effects and were replaced when the medication did not substantially improve ADHD symptoms after 2 weeks or after having doubled the dose.

Abbreviations: ADHD, attention deficit hyperactivity disorder; ASI, Addiction Severity Index; bid, two times per day; biw, two times per week; BSCS, Brief Substance Craving Scale; CBGT, cognitive-behavioral group therapy; CBT, cognitive-behavioral therapy; CCQ-Brief, Cocaine Craving Questionnaire-Brief; CCQ-GEN, Cocaine Craving Questionnaire-General; CGI, Clinical Global Impression Scale; IR, immediate-release; LA, long-acting; MPH, methylphenidate; qid, four times per day; qw, once per week; SEQ, Side Effects Questionnaire; SR, sustained-release; tid, three times per day; tiw, three times per week.

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