Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

TABLE 26.1. (continued)Indication26. Psychopharmacological Treatments 605Interaction with methadone or LAAMOther medications (cont.)Nevirapine HIV ↓ Methadone levels, withdrawal symptoms(Altice et al., 1999)Delavirdine HIV No significant effect on methadone; ↑ LAAMlevels (McCance-Katz et al., 2003)Efavirenz HIV ↓ Methadone levels associated with withdrawal(Clarke et al., 2000; McCance-Katz et al.,2002)Nelfinavir HIV ↓ Methadone levels, but no withdrawalsymptoms observed (Hsyu et al., 2000); casereport of methadone withdrawal (McCance-Katz et al., 2000)↑ norLAAM and ↓ dinerLAAM (McCance-Katz et al., 2003)Ritonavir HIV No significant effect on methadone (McCance-Katz et al., 2003)Lopinavir HIV ↓ Methadone levels, withdrawal symptoms(McCance-Katz et al., 2003)Note. Data from McCance-Katz, Cropsey, and Gourevitch.and type of psychotherapeutic intervention. Naltrexone will need to be examinedin larger, controlled clinical trials to determine its efficacy as a cocainepharmacotherapy.Future Directions for Cocaine PharmacotherapyMedications development continues for the treatment of cocaine addiction.Preclinical research focusing on medications that bind the dopamine D 1,D 2,and D 3receptors is ongoing, although no studies have yet been conducted inhumans. A cocaine vaccine is also in clinical trials. Anticocaine antibodieshave been developed and have been shown in animal studies to inhibit selfadministration.The presence of antibody has also been shown to reduce braincocaine levels following intravenous or intranasal cocaine administration (Fox,Kantak, & Edwards, 1996). The vaccine is structurally similar to cocaine, but iscoupled to a carrier protein that prevents rapid metabolism, thus making it possibleto mount an immune response to cocaine (Fox, 1997). The results of clini-