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The principles of agonist pharmacotherapy for psychostimulant dependence
Author(s) -
SHEARER JAMES
Publication year - 2008
Publication title -
drug and alcohol review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.018
H-Index - 74
eISSN - 1465-3362
pISSN - 0959-5236
DOI - 10.1080/09595230801927372
Subject(s) - agonist , methylphenidate , dopamine agonist , pharmacotherapy , pharmacology , amphetamine , stimulant , partial agonist , endogenous agonist , modafinil , medicine , dopamine , psychology , receptor , psychiatry , dopamine receptor d1 , attention deficit hyperactivity disorder
Issues . Psychostimulant dependence is a chronic, relapsing condition which is highly treatment refractory. No medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Agonist strategies have attracted limited attention. Approach . Successful examples of agonist pharmacotherapy in the treatment of heroin and nicotine dependence are first considered. Agonist pharmacological approaches to the treatment of psychostimulant dependence are then examined, based on the dopamine receptor agonist and indirect dopamine agonist strategies. Finally, the potential extension of the concept of agonist pharmacotherapy to include the novel non‐amphetamine‐type stimulant, modafinil, is discussed. Conclusions . Agonist approaches appear to be viable with risks outweighed by benefits in carefully selected, monitored and motivated patients. On the other hand, the effectiveness of indirect agonists such as dexamphetamine and methylphenidate are not established. Further research is required to determine optimal treatment models (whether maintenance or withdrawal), effective safe dosages and duration (short or long term).