Medication Protocol for Cocaine Detox
No specific medication is recommended for cocaine withdrawal itself, as withdrawal is best managed in a supportive environment with symptomatic treatment only. 1
Core Management Approach
Primary Strategy: Supportive Care Without Specific Pharmacotherapy
The WHO guidelines explicitly state that withdrawal from cocaine is best undertaken in a supportive environment with no specific medication recommended for the treatment of withdrawal. 1 This represents the highest-level guideline evidence available and should frame all management decisions.
Symptomatic Medication Management
Relief of specific symptoms (agitation, sleep disturbance) may be achieved with symptomatic medication for the period of the withdrawal syndrome. 1
For Agitation:
- Benzodiazepines are the foundation for controlling agitation during cocaine withdrawal 2
- Use short-term only (7-14 days) to prevent benzodiazepine dependence 2
- Options include diazepam or clonazepam at low doses 2
For Sleep Disturbance:
- Benzodiazepines can address insomnia during the acute withdrawal phase 2
- Limit duration to avoid creating secondary dependence 2
Monitoring for Psychiatric Complications
Depression or psychosis can occur during withdrawal, though less commonly. 1 When these develop:
- Monitor the individual closely 1
- Seek specialist advice if available 1
- Assess and treat coexisting psychiatric disorders (depression, anxiety, bipolar disorder) which are common in cocaine users 2
Post-Withdrawal Relapse Prevention
After the acute withdrawal phase, consider:
- Naltrexone 50 mg/day may reduce craving and prevent relapse 2
- Disulfiram may increase point abstinence rates 3
- Topiramate (escalating to 300 mg/day) may increase cocaine-free days 4
Psychosocial Interventions (Essential Component)
Short-duration psychosocial support modeled on motivational principles should be offered for psychostimulant use disorders in non-specialized settings. 1 This includes:
- Brief intervention comprising a single session of 5-30 minutes 1
- Individualized feedback and advice on reducing or stopping cocaine use 1
- Offer of follow-up 1
Pharmacological treatment is most effective when combined with psychosocial and behavioral interventions. 2
Critical Safety Considerations
Cardiovascular Monitoring
- Monitor vital signs, especially with history of cardiovascular complications 2
- Avoid beta-blockers within 72 hours of cocaine use, as they can potentiate coronary vasospasm 2
Medications to Avoid
- Dexamphetamine should NOT be offered for treatment of stimulant use disorders 1
Clinical Pitfalls
The most common error is prescribing specific "detox medications" when none are indicated. The evidence consistently shows that cocaine withdrawal does not require pharmacological detoxification protocols like those used for alcohol or opioids. 1 The focus should be on: