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Ritanserin in the treatment of cocaine dependence

  • Bankole A. Johnson
    Correspondence
    Address reprint requests to Dr. Bankole A. Johnson, Director, Clinical, Laboratory, and Experimental Alcohol Research, University of Texas-Houston, Health Science Center, Department of Psychiatry and Behavioral Sciences, 1300 Moursund, Houston, TX 77030.
    Affiliations
    Clinical, Laboratory, and Experimental Alcohol Research the Department of Psychiatry and Behavioral Sciences, Health Science Center, University of Texas, Houston, Texas, USA
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  • Y. Richard Chen
    Affiliations
    Clinical, Laboratory, and Experimental Alcohol Research the Department of Psychiatry and Behavioral Sciences, Health Science Center, University of Texas, Houston, Texas, USA
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  • Alan C. Swann
    Affiliations
    Clinical, Laboratory, and Experimental Alcohol Research the Department of Psychiatry and Behavioral Sciences, Health Science Center, University of Texas, Houston, Texas, USA
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  • Joy Schmitz
    Affiliations
    Clinical, Laboratory, and Experimental Alcohol Research the Department of Psychiatry and Behavioral Sciences, Health Science Center, University of Texas, Houston, Texas, USA
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  • Jary Lesser
    Affiliations
    Clinical, Laboratory, and Experimental Alcohol Research the Department of Psychiatry and Behavioral Sciences, Health Science Center, University of Texas, Houston, Texas, USA
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  • Pedro Ruiz
    Affiliations
    Clinical, Laboratory, and Experimental Alcohol Research the Department of Psychiatry and Behavioral Sciences, Health Science Center, University of Texas, Houston, Texas, USA
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  • Philip Johnson
    Affiliations
    Department of Internal Medicine, Hermann Hospital, University of Texas, Houston, Texas, USA
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  • Christopher Clyde
    Affiliations
    Janssen Research Foundation, Titusville, New Jersey, USA
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      Sixty-five cocaine-dependent subjects were enrolled into a 10-week randomized, double-blind study to determine the safety and efficacy of the serotonin-2 receptor antagonist, ritanserin (10 mg/day), in reducing cocaine consumption and craving. All subjects also participated in a structured intensive outpatient psychosocial program. Seventy-three percent of the participants completed the treatment program and follow-up. Subjects experienced a significant reduction in craving: 66.4% and 32.5% for the placebo and ritanserin groups, respectively. These reductions in craving were not paralleled by substantial decreases in cocaine use. Self-reported cocaine use was less frequent in the placebo group; paradoxically, blood levels of its metabolite, benzoylecgonine, were also higher although insignificantly so. Generally, ritanserin was well tolerated but significantly prolonged the QTc interval on the electrocardiogram. This outpatient program is effective at maintaining cocaine-dependent individuals in treatment and reducing craving. Ritanserin (10 mg/day) is not an efficacious adjunct to psychosocial treatment for cocaine dependence.

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