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Abstract
Background: Entacapone is a COMT inhibitor approved for the treatment of Parkinson’s disease. Due to its selective action over prefrontal dopamine availability, it can be a viable alternative to reduce craving for several substances of abuse. We report two cases of cocaine addiction in which entacapone was initiated and produced beneficial effects with good tolerability. Case descriptions: The first patient abused cocaine for the past 2 years, with an average of two daily doses. He was also diagnosed with psychosis not otherwise specified 1 year before. The second patient was on treatment substitution program with methadone and abused cocaine for the past 15 years, with a present daily use of four doses. For both patients, despite psychological therapy they maintained daily cocaine abuse. Entacapone 200 mg was initiated 4tid, with the possibility for an increase to 400 mg 4tid. Over the following 4 weeks, patients were assessed every week: self-reported number of cocaine weekly doses; EMIT urine assays for cocaine; perceived craving, self-control; and cocaine effect. Conclusions: Self-reported consumption of cocaine reduced as well as the number of positive EMIT urine assays and perceived craving, while perceived self-control increased. This is the first study reporting the use of a COMT inhibitor for cocaine addiction. Despite the positive results, no recommendations can be made regarding the use of entacapone for cocaine addiction. However, this should raise interest to the potential benefit of a new drug class for cocaine addiction and motivate further studies with larger samples and improved methodological quality.