Mazindol augmentation of antipsychotic treatment for schizophrenic patients with comorbid cocaine abuse or dependence: A preliminary double-blind, randomized, placebo-controlled trial

Objectives: Cocaine abuse has a negative impact on the natural history of schizophrenia. There are no proven treatments for cocaine abuse in schizophrenia patients. The catecholamine reuptake inhibitor, mazindol, has been reported to reduce cocaine abuse in some studies. Here we report the results of a double-blind, randomized, placebo-controlled 6-week pilot study of mazindol augmentation of antipsychotic pharmacotherapy in patients diagnosed with comorbid schizophrenia and cocaine abuse or dependence. Methods: Patients diagnosed with schizophrenia or schizoaffective disorder and cocaine abuse or dependence participated in group therapy focused on substance abuse issues and were randomly assigned to mazindol (1 mg tid, increased to 2 mg tid after 1 week) or matched placebo in addition to their current antipsychotic medication for 6 weeks. Results: Twenty-four patients were included in the analysis, with 11 and 13 randomized to the mazindol and placebo groups, respectively. While safe and well-tolerated, mazindol was ineffective in reducing cocaine consumption, cocaine craving, and psychiatric symptoms. Conclusions: These results do not support the efficacy of mazindol in decreasing cocaine craving, cocaine consumption, and psychiatric symptoms in schizophrenic and schizoaffective patients.