A double-blind placebo-controlled trial of N-acetylcysteine in the treatment of cocaine dependence
Version of Record online: 15 MAY 2013
Copyright © American Academy of Addiction Psychiatry
The American Journal on Addictions
Volume 22, Issue 5, pages 443–452, SeptemberߝOctober 2013
How to Cite
LaRowe, S. D., Kalivas, P. W., Nicholas, J. S., Randall, P. K., Mardikian, P. N. and Malcolm, Robert. J. (2013), A double-blind placebo-controlled trial of N-acetylcysteine in the treatment of cocaine dependence. The American Journal on Addictions, 22: 443–452. doi: 10.1111/j.1521-0391.2013.12034.x
- Issue online: 18 AUG 2013
- Version of Record online: 15 MAY 2013
- Manuscript Accepted: 12 MAR 2012
- Manuscript Revised: 4 JAN 2012
- Manuscript Received: 7 NOV 2011
There remains no FDA approved medication for the treatment of cocaine dependence. Preclinical studies and early pilot clinical investigations have suggested that N-acetylcysteine (NAC) may be useful in the treatment of the disorder.
The present report assessed the efficacy of NAC in the treatment of cocaine dependence.
Cocaine-dependent volunteers (n = 111) were randomized to receive daily doses of 1,200 mg of NAC, 2,400 mg of NAC, or placebo. Participants were followed for 8 weeks (up to three visits weekly). At each of these visits, urine samples were collected, along with self-reports of cocaine use. Urine samples were assessed for quantitative levels of benzoylecognine (ie, cocaine metabolite).
Overall, the primary results for the clinical trial were negative. However, when considering only subjects who entered the trial having already achieved abstinence, results favored the 2,400 mg NAC group relative to placebo, with the 2,400 mg group having longer times to relapse and lower craving ratings.
While the present trial failed to demonstrate that NAC reduces cocaine use in cocaine-dependent individuals actively using, there was some evidence it prevented return to cocaine use in individuals who had already achieved abstinence from cocaine.
N-acetylcysteine may be useful as a relapse prevention agent in abstinent cocaine-dependent individuals. (Am J Addict 2013;22:443–452)