The anti-platelet agent Clopidogrel and the vasodilator isradipine are proposed to treat chronic cocaine abusers who have regional cerebral blood flow (rCBF) defects identified with Tc-HMPAO-SPECT. These rCBF defects may be related to highly abnormal platelet activation that can- lead to platelet thrombi as small cerebral arterioles vasoconstrict secondary to release of vasoactive compounds from these platelets. We are currently engaged in a randomized clinical trial comparing a standard clinical dose of an antiplatelet agent aspirin to placebo, but in a preliminary analysis- in which Aspirin is reducing platelet adhesion, the rCBF defec~are only partially responding. However, the new antiplatelet agent clopidogrel, which also vasodilates, has been shown to be more effective than aspirin in clearing platelet thrombi. Thus, we will test it and isradipine because this calcium channel blocker aftenuates -cocaine-induced vasoconstriction. Three hypotheses are considered. First, inhibition ofplateletfi?nction and vasodilation in chronic cocaine abusers could enhance the resolution of cocaine-related CBF abnormalities. Second, we hypothesize a positive correlation between improvement in rCBF defects and neuropsychological test peiformance, which has shown impairment in over 50% of cocaine dependent patients. We also have previously shown a correlation between these baseline cognitive deficits and rCBF defects. Third, with improvement in cognitive~nction then the efficacy for relapse prevention of our subsequent outpatzent care using cognitive behavioral therapy will be improved. To test these hypotheses the study design is a four-week, residential trial followed by 8 weeks of outpatient care. Cocaine-dependent subjects with defects in rCBF are randornized to placebo vs clopidogrel 75 mg during years 1-3 and to placebo vs isradipine 10 mg during years 3-5. We will measure rCBF and neuropsychological test performance at intake and after four weeks of treatment and then assess urine toxicologies three thnes weekly for weeks 5-12 as outpatients. Regional cerebral perfiision will be assessed using technetiurn~99m-D,L-hexamethyl propyleneamine oxime (HMPAO) and single photon emission computed tomography (SPECT) on a Prism 3000 xP, a state-of-the-art triple-headed garmna camera. For these studies we also have developed irnage analyses using distribution based scaling and deficit burden analysis that compare our scans to our own normal database for statistical parametric mapping.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Specialized Center (P50)
Project #
1P50DA012762-01
Application #
6225139
Study Section
Special Emphasis Panel (ZDA1-KXA-N (27))
Project Start
1999-09-30
Project End
2004-08-31
Budget Start
Budget End
Support Year
1
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Yale University
Department
Type
DUNS #
082359691
City
New Haven
State
CT
Country
United States
Zip Code
06520
Bashiri, Maryam; Mancino, Michael J; Stanick, Virginia A et al. (2017) Moderators of response to sertraline versus placebo among recently abstinent, cocaine dependent patients: A retrospective analysis of two clinical trials. Am J Addict 26:807-814
DeVito, Elise E; Herman, Aryeh I; Konkus, Noah S et al. (2017) Atomoxetine in abstinent cocaine users: Cognitive, subjective and cardiovascular effects. Pharmacol Biochem Behav 159:55-61
Mancino, Michael J; McGaugh, Janette; Chopra, Mohit P et al. (2014) Clinical efficacy of sertraline alone and augmented with gabapentin in recently abstinent cocaine-dependent patients with depressive symptoms. J Clin Psychopharmacol 34:234-9
Orson, Frank M; Rossen, Roger D; Shen, Xiaoyun et al. (2013) Spontaneous development of IgM anti-cocaine antibodies in habitual cocaine users: effect on IgG antibody responses to a cocaine cholera toxin B conjugate vaccine. Am J Addict 22:169-74
Oliveto, Alison; Poling, James; Mancino, Michael J et al. (2012) Sertraline delays relapse in recently abstinent cocaine-dependent patients with depressive symptoms. Addiction 107:131-41
Sofuoglu, Mehmet; Mooney, Marc; Kosten, Thomas et al. (2011) Minocycline attenuates subjective rewarding effects of dextroamphetamine in humans. Psychopharmacology (Berl) 213:61-8
Mancino, Michael J; Gentry, Brooks W; Feldman, Zachary et al. (2011) Characterizing methamphetamine withdrawal in recently abstinent methamphetamine users: a pilot field study. Am J Drug Alcohol Abuse 37:131-6
Kinsey, Berma M; Kosten, Thomas R; Orson, Frank M (2010) Active immunotherapy for the Treatment of Cocaine Dependence. Drugs Future 35:301-306
Martell, Bridget A; Orson, Frank M; Poling, James et al. (2009) Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients: a randomized, double-blind, placebo-controlled efficacy trial. Arch Gen Psychiatry 66:1116-23
Sofuoglu, Mehmet; Poling, James; Hill, Kevin et al. (2009) Atomoxetine attenuates dextroamphetamine effects in humans. Am J Drug Alcohol Abuse 35:412-6

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