Valproate treatment and cocaine cue reactivity in cocaine dependent individuals.
Valproate treatment and cocaine cue reactivity in cocaine dependent individuals.
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DOI：
10.1016/j.drugalcdep.2009.02.010
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发表时间：
2009-06-01
影响因子：
4.2
通讯作者：
Thakkar, Vatsal
中科院分区：
文献类型：
--
作者：
Reid, Malcolm S.;Thakkar, Vatsal
先前的临床试验表明，基于 γ-氨基丁酸 (GABA) 的抗惊厥药物可减少可卡因依赖研究参与者的药物渴望，我们测试了丙戊酸治疗对提示诱发的可卡因渴望的影响。采用随机、安慰剂对照、受试者内交叉研究设计对快克可卡因依赖个体 (N=20) 进行了测试。丙戊酸治疗在治疗第 6 天滴定至 1500 毫克/天，线索测试在治疗第 8 天完成，所有研究参与者在活性药物治疗和安慰剂治疗之间经历了 5 天的清除期。测试包括可卡因和中性线索暴露课程，以随机和平衡的顺序进行。线索暴露的主要影响是对“现在使用可卡因的愿望”、可卡因渴望指数、可卡因样高和可卡因戒断的主观评级的影响。发现治疗相互作用效应与“现在使用可卡因的愿望”有关，在丙戊酸条件下接触可卡因线索后，这种效应出现了更大的增加。研究发现，药物治疗的主要作用是降低血压和心率，以及升高血浆皮质醇水平，这些效果与丙戊酸钠治疗相关。在趋势水平上，丙戊酸治疗还与测试前较高的可卡因渴望水平相关。结果表明，可卡因提示反应性在两次评估过程中是一个强有力的现象，但不支持使用丙戊酸盐作为减少自发和提示诱发的可卡因渴望的手段。不支持使用丙戊酸治疗可卡因依赖。
Based on prior clinical trials indicating that γ-aminobutyric acid (GABA) based anticonvulsant medications reduce drug craving in cocaine dependent study participants, we tested the effects of valproate treatment on cue-induced cocaine craving. Crack cocaine dependent individuals (N=20) were tested in a randomized, placebo-controlled, within-subjects, crossover study design. Valproate treatment was titrated up to 1500 mg/day by Day 6 of treatment, cue testing was completed on Day 8 of treatment, and all study participants underwent a washout period of 5 days between active and placebo medication treatment periods. Testing included both cocaine and neutral cue exposure sessions, presented in a random and counterbalanced order. Main effects of cue exposure were found for subjective ratings of “desire to use cocaine now”, the cocaine craving index, cocaine-like high, and cocaine withdrawal. Treatment interaction effects were found with “desire to use cocaine now”, which underwent a greater increase following cocaine cue exposure in the valproate condition. Main effects of medication treatment were found, in which lower blood pressure and heart rate, and higher plasma cortisol levels, were associated with valproate treatment. Valproate treatment was also associated, at a trend level, with higher pre-test cocaine craving levels. The results demonstrate that cocaine cue reactivity is a robust phenomena across two assessment sessions, but fail to support the use of valproate as a means of reducing spontaneous and cue-induced cocaine craving. The use of valproate as a treatment for cocaine dependence is not supported.
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