ARIPPRIPAZOLE AND ITS POTENTIAL EFFECT IN REDUCING COCAINE CRAVING IN SCHIZOPHRENIC PATIENTS WITH COCAINE-DEPENDENCE

Abstract

Goals: Non-systematic literature review of the role of aripiprazole in alleviating cocaine craving in schizophrenic patients with cocaine-dependence (CD). Material and methods: From the review performed, 2 studies outstand: In one study, 6 schizophrenic patients with CD completed 8 weeks of treatment with aripiprazole at a maximum dose of 15 mg/d. The Brief Psychiatric Rating Scale and the Brief Substance Craving Scale (BSCS) were used to measure psychosis and subjective cocaine and alcohol cravings and urine tests for cocaine were performed. In another study, 44 CD patients with schizophrenia or schizoaffective disorder were treated with aripiprazole or perphenazine during 8 weeks. The perphenazine group received the recommended dosage not exceeding 24 mg/d and the patients receiving aripripazole were started on 15 mg/d to a maximum of 30 mg/d or a minimum of 10 mg/d. Primary outcome targeted cocaine-free urine sample proportions, whereas secondary outcome focused on cocaine craving scores. BSCS was used to assess cocaine craving and the positive and negative symptom scale and the clinical global impression scale were used to monitor psychotic symptom severities. Results and conclusion: In the first study, positive urine tests dropped significantly after 2 weeks, mean cocaine and acohol craving scores declined significantly, and declining psychosis scores were associated with declining cocaine and alcohol craving. In the second study, the proportion of negative drug test results did not differ significantly between patients treated with aripiprazol or perphenazine. Regarding the anticraving effect, in the aripiprazol group during week 3 to 8, significant reductions in craving intensity, frequency and duration were seen, while no similar reduction was seen with perphenazine. In conclusion, although the results are still limited, studies suggest that aripiprazol may have a potential effect in dual diagnosis patients with schizophrenia and CD, possibly due to its dopamine activity as a partial agonist/antagonist.