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

Abstract

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. 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. 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. 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.