Treatments for Amphetamine Dependence and Abuse

A Cochrane review [Abstract] 1 [withdrawn from publication] on amphetamine dependence and abuse included 4 studies with a total of 173 subjects. The studies investigated fluoxetine, amlodipine, imipramine and desipramine. In comparison to placebo, short-term treatment of fluoxetine (40 mg/day) significantly decreased craving. In comparison to imipramine 10 mg/day, medium-term treatment of imipramine 150 mg/day significantly increased the duration of adherence to treatment. All four drugs had no benefits on a variety of outcomes, including amphetamine use.

A Cochrane review [Abstract] 2 on amphetamine withdrawal included 4 studies with a total of 125 subjects. 2 studies found that amineptine (amineptine has been withdrawn from the market due to reports of amineptine abuse) significantly reduced discontinuation rates and improved overall clinical presentation, but did not reduce withdrawal symptoms or craving compared to placebo. One study suggested that mirtazapine may reduce hyperarousal and anxiety symptoms associated with amphetamine withdrawal. A more recent study failed to find any benefit of mirtazapine over placebo on retention or on amphetamine withdrawal symptoms.

A Cochrane review [Abstract] 3 included 11 studies with a total of 791 subjects. Studied psychostimulants included dexamphetamine, bupropion, methylphenidate and modafinil. No significant differences were found between psychostimulants and placebo for any of the studied efficacy outcomes. Overall retention in studies was low (50.4%). Psychostimulants did not reduce amphetamine use (mean difference (MD) -0.26, 95% confidence interval (CI) -0.85 to 0.33) or amphetamine craving (MD 0.07, 95% CI -0.44 to 0.59) and did not increase sustained abstinence (relative risk (RR) 1.12, 95% CI 0.84 to 1.49). The proportion of adverse events inducing dropout was similar for psychostimulants and placebo.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by imprecise results (few patients).

References

• Srisurapanont M, Jarusuraisin N, Kittirattanapaiboon P et al. WITHDRAWN: Treatment for amphetamine dependence and abuse. Cochrane Database Syst Rev 2014;(4):CD003022. [PubMed]
• Shoptaw SJ, Kao U, Heinzerling K, Ling W. Treatment for amphetamine withdrawal. Cochrane Database Syst Rev 2009;(2):CD003021. [PubMed]
• Pérez-Mañá C, Castells X, Torrens M et al. Efficacy of psychostimulant drugs for amphetamine abuse or dependence. Cochrane Database Syst Rev 2013;(9):CD009695. [PubMed]