Method of Treating Psychostimulant Addiction

In the present invention, it has been found that psychostimulant abuse can be treated by administering to a human abuser a dopamine agonist in an amount which is effective in inhibiting or eliminating the need for the drug during and after withdrawal. More particularly, it has been found that the withdrawal symptoms resulting from the abrupt cessation of chronic high dose use of psychostimulants can be significantly reduced or eliminated by the administration of an effective amount of a dopamine agonist. The dopamine agonist can be any dopamine stimulating agent, such as, levodopa, bromocriptine, bupropion, pergolide, lisuride and lergotrile, to name a few. The preferred dopamine agonist in the invention is bromocriptine. The amount of agonist administered will vary depending on the active agent used and the patient undergoing treatment. Essentially it will be the same as the known therapeutic dosage. It has however been surprisingly found that particularly good results are obtained in the majority of cases with daily dosages significantly lower than those administered for their known indications. The therapeutically effective amount of levodopa is from 0.5 to 1.0 gram per day. Bromocriptine is generally administered in dosages ranging from 0.1 to 10 milligrams per day. Pergolide and lisuride are effective at daily doses of about 0.05 to 1.0 milligram. Generally, the daily dosage for the ergolene and ergoline type dopamine agonist will be from about 0.05 to about 20 milligrams per day. The daily dosage for non-ergoline type agonists will normally be from 5 to 1000 milligrams per day. The agonist can be administered on a set schedule, for example, every 4 to 6 hours, or it can be administered in accordance with the patient's requirement. The preferred agonist, bromocriptine, is administered in unit doses of about 0.5 to 2.5 milligrams 2 to 4 times daily, preferably about 0.5 to 1.0 milligram 2 to 3 times daily. Normally, a unit dose of about 0.5 to 1 milligram of bromocriptine as required is sifficient to reduce or eliminate the desire for the psychostimulant being abused. It will be appreciated that such doses are significantly lower than those administered for the known indications of this drug, which range from about 2.5 to about 50 milligrams daily.

When appropriate, the dopamine agonist used in the invention may be employed in free base form or in pharmaceutically acceptable salt form. The various ergolene derivatives referred to above may, for example, be used in the form of the mesylate or hydrochloride salt. Generally, the activities of such salt forms will be of the same order as that of the corresponding free base form, and references to compounds in the free base form throughout the specification and claims are to be understood as including known salt forms.

The active agent of the invention may be administered orally or parenterally as such or admixed with conventional pharmaceutical carriers. They may be administered orally in such forms as tablets, dispersible powders, granules, capsules, syrups and elixirs, or parenterally as solutions, e.g., a sterile injectable aqueous solution. Tablets may contain the active ingredients in admixture with conventional pharmaceutically acceptable excipients, e.g., inert diluents and granulating, disintegrating and lubricating agents. The tablets may be uncoated or coated by known techniques to delay disintegration and absorption in the gastrointestinal tract and thereby provide a sustained action over a longer period. Similarly, suspensions, syrups and elixirs may contain the active ingredients in admixture with any of the conventional excipients utilized in the preparation of such compositions. Capsules may contain the active ingredients alone or admixed with an inert solid diluent. The injectable compositions are formulated as known in the art. These pharmaceutical preparations may contain up to about 90% of the active ingredients in combination with the carrier or adjuvant.

Pharmaceutical compositions containing the most preferred compound, bromocriptine mesylate, at dosages of 2.5 and 5 milligrams and suitable for oral administration in accordance with the method of the invention are commercially available. The tablet form is readily broken in half or into quarters for administration of lower doses. Preferably quarters of the 2.5 milligram form are administered 2 to 3 times a day. Alternatively unit dosage forms containing equivalent dosages, e.g. 0.5 milligrams may be employed.

In one patient study, nine patients, four male and five female, ranging in age from 18 to 34, were treated for cocaine withdrawal symptoms with commercially available bromocriptine mesylate. The average length of addiction was four years. Approximately one hour after the last use of the drug, abstinence symptoms began, and reached their peak in three days. After admission to the study, the nine patients were given 0.625 milligrams p.o. of bromocriptine mesylate. The withdrawal symptoms subsided in all patients for periods ranging from 4.5 to 6 hours. Repeated dosing for 1 to 2 weeks permitted the patients to remain free of the most serious symptoms and eventually to enter the group therapy stage of the recovery program.

In a second study, two female in-patients, ages 18 and 20, gave informed consent to receive either bromocriptine or placebo. Both patients were contemplating leaving the hospital to use cocaine; and each complained of depressed mood, anergia, suicidal ideation, and poor concentration. The diagnosis of cocaine abuse was established after a complete evaluation and comprehensive testing to rule out other drug abuse and any medical illness. The patients were asked to rate the degree of craving for cocaine by marking a 100 millimeter line anywhere between "not at all" and "extreme". Scores were assigned according to the point marked, ranging between 0 and 100. Craving was again self-rated at varying time points after 0.625 milligrams p.o. of bromocriptine mesylate or placebo were administered blindly. The results of the cocaine urge self rating before and after placebo or bromocriptine administration is shown in FIG. 1. As can be seen from the figure, both patients reported marked and consistent relief from cocaine craving after taking bromocriptine. In patient No. 1, the cocaine urge self rating dropped from about 60 to about 5 in two hours upon administration of the bromocriptine. In patient No. 2, the cocaine urge self rating dropped from about 75 to about 20 in 90 minutes upon administration of bromocriptine in one rating session, and from about 50 to about 5 in 75 minutes in another session. In addition, both patients were able to distinguish bromocriptine from placebo in all six trials. Afterwards, Subject 1 was given the dopamine antagonist, thioridazine, for the treatment of visual hallucinations and reported an acute increase in cocaine craving. When the effect of the dopamine antagonist on cocaine urges was assessed, craving in two trials increased from baseline scores of 7 and 15 to scores of 30 and 70 respectively after 30 minutes. The results of the study show that cocaine withdrawal symptoms are significantly reduced by the administration of a dopamine agonist, while cocaine urges are exacerbated by dopamine antagonists.

In a further study, a patient was treated for amphetamine abuse with commercially available bromocriptine mesylate. Shortly after the last use of amphetamine, abstinence symptoms began. The patient was given 0.625 milligrams p.o. of bromocriptine mesylate, and withdrawal symptoms subsided. Repeated dosing as needed permitted the patient to remain free of the most serious symptoms.

The present invention also provides a pharmaceutical composition containing a dopamine agonist for use in the treatment of psychostimulant addiction.

Tablets having a diameter of 6 millimeters and the following composition may be prepared according to conventional methods and are suitable for use in the treatment of psychostimulant addiction.

(0.574 milligrams of bromocriptine mesylate correspond to 0.5 milligrams of the free base form.)