RESUMO

BACKGROUND: Several studies have demonstrated that ACh modulates the dopaminergic circuit in the nucleus accumbens, and its blockade appears to be associated with the inhibition of the reinforced effect or the increase in dopamine caused by cocaine use. The objective of this study was to evaluate the effect of biperiden (a muscarinic receptor antagonist with a relatively higher affinity for the M1 receptor) on crack/cocaine use relapse compared to a control group that received placebo. METHODS: This study is a double-blind, randomized, placebo-controlled clinical trial. The intervention group received 2 mg of biperiden, 3 times a day, for a period of 3 months. The control group received identical placebo capsules, at the same frequency and over the same period. All participants were followed for a period of six months. RESULTS: The sample comprised 128 people, with 61 in the control group and 67 in the biperiden group. Lower substance consumption was observed in the group that received biperiden treatment two (bT2 = -2.2 [-3.3; -1.0], p < 0.001) and six months (bT4 = -6, 2 [-8.6; -3.9], p < 0.001) after the beginning of the intervention. The biperiden group had a higher latency until a possible first day of consumption, in the same evaluation periods (bT2 = 0.26 [0.080; 0.44], p = 0.004; bT4 = 0.63 [0.32; 0.93], p < 0.001). CONCLUSIONS: Despite the major limitations of the present study, the group that received biperiden reduced the number of days of cocaine/crack use and showed an increase in the latency time for relapse. More studies are needed to confirm the utility of this approach.

Assuntos

RESUMO

Cocaine use affects approximately 13.4 million people, or 0.3% of the world's population between 15 and 64 years of age. Several authors have described drug addiction as a disease of the brain reward system. Given that the cholinergic system impacts reward mechanisms and drug self-administration, acetylcholine (ACh) might play an important role in the cocaine addiction process. We evaluated the efficacy of biperiden (a cholinergic antagonist) in reducing craving and the amount used, and in increasing compliance with treatment for cocaine/crack addiction. It was a study double-blind, randomised, placebo-controlled, 8-week trial of 111 cocaine or crack addicted male patients between 18 and 50 years old. Two groups were compared: placebo (n=55) or biperiden (n=56) combined with weekly sessions of brief group cognitive-behavioural therapy. The efficacy of treatment was evaluated according to the patients' compliance and several instruments: the Minnesota Cocaine Craving Scale, the Beck Depression and Anxiety Scales and a questionnaire assessing the amount of drug used. All of the patients attended weekly sessions for two months. We analysed the data considering the patients' intention to treat based on our last observation. Of the 56 patients in the biperiden group, 24 completed the treatment (42.8%) compared with only 11 patients in the placebo group (20%), which was a significant difference (p=0.009). Compliance with treatment was 118% higher in the biperiden group, which was also the group that presented a statistically significant reduction in the amount of cocaine/crack use (p<0.001). There was statistically significant difference between the craving score in the biperiden group. Pharmacological blockade of the cholinergic system with biperiden is a promising alternative to treat cocaine/crack addiction, helping patients to reduce the amount used and improving compliance with psychotherapy treatment.

Assuntos

RESUMO

Introducción: El abuso de fármacos anticolinérgicos es un problema que ocasionalmente se ha reportado en la literatura médica aunque al parecer su frecuencia puede ser mayor a lo considerado usualmente; sobre todo en pacientes con esquizofrenia, donde se indica anticolinérgicos para contrarrestar los síntomas extrapiramidales secundarios al uso de antipsicóticos, es donde se detectan la mayoría de casos. Método: reportamos cuatro casos de pacientes con esquizofrenia que abusaban de anticolinérgicos y revisamos la literatura pertinente. Resultados: El uso excesivo de anticolinérgicos por pacientes con esquizofrenia ha sido atribuido a su intento de controlar síntomas depresivos o negativos o la disforia inducida por antipsicóticos sin embargo no hay usualmente correlación entre el uso de antipsicóticos y el abuso de anticolinérgicos; por tanto, es menester considerar el potencial de abuso de los anticolinérgicos. Conclusión: Se impone revisar la indiscriminada prescripción de fármacos anticolinérgicos a los usuarios de antipsicóticos de modo tal que el riesgo de abuso se detecte tempranamente.

Introduction: The abuse of anticholinergic drugs is a problem occasionally reported in the medical literature although it has been suggested that its frequency is higher than usually considered. Since the main indication of anticholinergics today is to alleviate extrapyramidal symptoms in patients using antipsychotics, several cases of excessive use of anticholinergic drugs in schizophrenic patients are detected in psychiatric practice. Method: We report four schizophrenic patients who used anticholinergic drugs in excessive doses and we review the respective bibliography. Results: The excessive use of anticholinergic drugs by schizophrenic patients has been attributed to their attempt to counteract their negative symptoms, depressive symptoms or the dysphoria induced by antipsychotics, however, there is not usually correlation between the use of neuroleptics and anticholinergics abuse; therefore it is necessary to take into account the addictive potential of antiparkinson drugs. Conclusion: We advise to review the extensive prescription of anticholinergic drugs to antipsychotic users so the risk of anticholinergic drug abuse can be detected early.

Assuntos