Methylphenidate for the Treatment of Cocaine Use Disorder: A Systematic Review and Meta-analysis.

Abstract

Objectives: Cocaine use disorder (CUD) is a chronic condition, often associated with attention deficit hyperactivity disorder (ADHD). No medications have been approved for the treatment of CUD, but methylphenidate (MPH) has been explored as a potential candidate. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of MPH in patients with CUD with and without ADHD.

Methods: Following PRISMA guidelines, we developed a search string for PubMed, ISI Web of Science, and Scopus databases. We included randomized and nonrandomized clinical studies that used MPH in CUD treatment.

Results: Twenty studies were included in the systematic review, 6 of them were included in the meta-analysis. In the meta-analysis, MPH did not reduce craving (ES: -0.33, 95% CI: 1.69 to 1.03; Z = -0.473; P = 0.636) or cocaine use (ES: -0.01, 95% CI: -0.35 to 0.33) (Z= -0.084; P = 0.933) compared with placebo. However, the route of administration and the presence of ADHD associated with CUD influenced the outcomes on cocaine craving measures. Similarly, although the results were inconclusive, a trend toward the reduction of cocaine consumption was observed in patients with ADHD treated with MPH. Regarding safety, MPH can be used in patients with CUD up to 90 mg/d and monitoring the cardiovascular parameters is strictly required.

Conclusions: Evidence on the efficacy of MPH for the treatment of CUD is still limited and inconclusive. However, there might be a rationale for its use in patients with both CUD and ADHD, therefore, further clinical studies are needed in this particular category.