Is Trazodone Contramid Useful in Inducing Patients to Refrain from Using Cocaine after Detoxification, so Avoiding Early Relapse? A Case Series

Objectives: So far, no specific medication has been approved by international drug regulatory agencies for the treatment of cocaine use disorder (CoUD). The reward deficiency syndrome (dysphoric-depressive) was originally described as an outcome after detoxification; it is now considered to be one of the possible routes to relapsing behavior. Materials and Methods: We describe the case of 9 consecutive patients affected by mono CoUD. They voluntarily stopped cocaine use for almost 2 weeks, after daily use for almost 2 months, entering into a dysphoric-depressive syndrome and experiencing a high level of craving for cocaine. All patients received trazodone contramid once a day, at bedtime, at an initial dose of 150 mg the first week, upgraded to 300 mg starting with the second week of treatment; they were followed up for 6 months. Results: Only 1 patient failed to complete 6-month follow-up, relapsing many times into cocaine use during the observational period. Another patient completed the follow-up while improving his psychiatric symptoms but relapsing 3 times into cocaine use. In total, 7/9 patients (77.8%) improved their psychiatric symptoms and, 6 months after starting therapy, remained cocaine-detoxified. Conclusions: The present case series shows that trittico contramid is probably able to positively modify psychopathologic symptomatology and cocaine craving in CoUD patients who voluntarily stopped cocaine use but were at high risk of early relapse. The current need is for controlled clinical trials to confirm the safety and efficacy of trittico contramid in avoiding early relapse in cocaine self-detoxified patients.