COCAINE DEPENDENCE

Drugs
Many medications—greater than twenty—have been tested but none have been found to reduce the intensity of withdrawal. Dopamine agonists like amantadineand bromocriptine and tricyclic antidepressants such as desipraminehave failed in studies to help treat symptoms of cocaine withdrawal or intoxication.

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Phentolamine
Used as an aid in the diagnosis of pheochromocytoma

Uses

Diagnosis of Pheochromocytoma

Used as an aid in the diagnosis of pheochromocytoma.

Determination of blood catecholamine concentrations, urinary assay of catecholamines, or other biochemical assays are the safest and most reliable diagnostic methods and they have largely replaced phentolamine and other pharmaceutical tests. No test, however, is completely reliable.

May be used when additional confirmatory evidence of pheochromocytoma is required and potential benefits outweigh the possible risks.

Test is more reliable with sustained than with paroxysmal hypertension; no diagnostic value in absence of hypertension at the time of the test.

Sudden and marked reduction in BP following parenteral administration of phentolamine suggests pheochromocytoma; however, false-negative and false-positive responses are frequent.

Hypertension in Pheochromocytoma

May be administered immediately prior to or during pheochromocytomectomy to prevent or control paroxysmal hypertension resulting from anesthesia, stress, or operative manipulation of the tumor.

Has been used to manage pheochromocytoma until surgery is performed and for prolonged treatment of hypertension when the tumor is not operable; however, phenoxybenzamine is considered the drug of choice because it has a longer duration of action.

Hypertensive Crises

Has been used to treat hypertensive crises caused by sympathomimetic amines† (e.g., methoxamine, phenylephrine) or catecholamine excess by certain foods or drugs in patients taking MAO inhibitors† (e.g., isocarboxazid [no longer commercially available in the US], tranylcypromine), or by clonidine withdrawal syndrome†.

If used, the initial goal is to reduce mean arterial BP by no more than 25% within minutes to 1 hour, followed by further reduction if stable toward 160/100 to 110 mm Hg within the next 2–6 hours, avoiding excessive declines in pressure that could precipitate renal, cerebral, or coronary ischemia.

If this BP is well tolerated and the patient is clinically stable, may implement further gradual reductions toward normal in the next 24–48 hours. In patients with aortic dissection, reduce systolic BP to <100 mm Hg if tolerated.

Extravasation of Catecholamines

Used to prevent dermal necrosis and sloughing following IV administration or extravasation of norepinephrine.

Has been used to prevent necrosis after extravasation of dopamine†.

MI

Has been used to decrease impedance to left ventricular ejection and the infarct size in patients with MI associated with left ventricular failure†.

However, contraindicated in patients with MI, and investigators do not recommend for routine use, since left ventricular function and the ECG must be monitored continuously.

Erectile Dysfunction

Self-injection of small doses combined with papaverine hydrochloride into the corpus cavernosum has been effective for the treatment of erectile dysfunction† (ED, impotence).

Combination has been effective in patients with neurogenic and/or limited vasculogenic impotence or with psychogenic impotence, but efficacy in those with a vasculogenic component of their impotence may be variable depending on the extent and type of vascular dysfunction.

Erection, which can be potentiated by sexual arousal, usually occurs within 10 minutes after injection of the drugs and may persist for 1 to several hours; tolerance to the drugs may occur during long-term use; priapism may occur.

Cocaine-induced Acute Coronary Syndrome

Used as an adjunct in the management of cocaine overdose† to reverse coronary vasoconstriction following use of oxygen, benzodiazepines (e.g., diazepam, lorazepam), and nitroglycerin.