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Letters   |    
Use of Extended-Release Methylphenidate (Concerta) in Treatment of Cocaine Dependence in a Patient Presenting With Attention Deficit Hyperactivity Disorder
Bruce Imbert, M.D.; Nathalie Labrune, M.D.; Christophe Lancon, M.D., Ph.D.; Nicolas Simon, M.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:E49-E50. doi:10.1176/appi.neuropsych.13080194
View Author and Article Information

The authors report no financial relationships with commercial interests.

Dept. of Addictology, Sainte-Marguerite University Hospital, APHM, Marseille, France

Dept. of Psychiatry, Sainte-Marguerite University Hospital, APHM, Marseille, France
Dept. of Addictology, Sainte-Marguerite University Hospital, APHM, Marseille, France
Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille, France

Dept. of Addictology, Sainte-Marguerite University Hospital, APHM, Marseille, France
Dept. of Clinical Pharmacology, Timone University Hospital, Marseille, France
Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille, France

Send correspondence to Dr. Imbert; e-mail: bruce.imbert@me.com

Copyright © 2014 American Psychiatric Association

Extract

To the Editor: Methylphenidate (MPH) is a central nervous system stimulant with limited peripheral actions1 used to treat attention deficit hyperactivity disorder (ADHD) in children. At the central level, MPH, like cocaine, blocks the dopamine transporter (DAT), particularly in the striate body and the nucleus accumbens, both regions involved in the process of positive reinforcement and reward (which would be dysfunctional in ADHD).2 MPH is generally well tolerated; most of its adverse effects are mild and/or temporary.3 As defined in the DSM-IV-TR, ADHD is a persistent and highly disabling mental disorder that is characterized by patterns of inattention, hyperactivity, and marked impulsivity, often complicated by co-occurring substance use disorders.4 It is estimated that 15%‒25% of cocaine abusers seeking treatment have ADHD.5,6 A recent review of the literature suggests that research on treatments such as MPH or amphetamine analogs of cocaine could help identify effective therapeutic molecules.7 MPH seems particularly promising, and a recent study showed its specific properties related to the mixed profile reuptake inhibitor of low-dose dopamine and deliverer of high-dose dopamine.8

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References

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Rush  CR;  Stoops  WW:  Agonist replacement therapy for cocaine dependence: a translational review.  Future Med Chem 2012; 4:245–265
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Ferris  MJ;  Calipari  ES;  Mateo  Y  et al:  Cocaine self-administration produces pharmacodynamic tolerance: differential effects on the potency of dopamine transporter blockers, releasers, and methylphenidate.  Neuropsychopharmacology 2012; 37:1708–1716
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Sussner  BD;  Smelson  DA;  Stephanie  R  et al:  The validity and reliability of a brief measure of cocaine craving.  Drug Alcohol Depend 2006; 83:233–237
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