A historically controlled trial of tyrosine for cocaine dependence.

Cocaine dependence continues to be a major public health problem and efforts to develop pharmacotherapies have been disappointing. Chronic cocaine use is believed to cause catecholamine depletion and similarities exist between cocaine withdrawal and major depression. Tyrosine is the dietary precursor to catecholamines and has yielded positive results in small trials of its antidepressant efficacy. Tyrosine 2 g every 8 hours was administered on an open-label basis to 49 cocaine-dependent individuals, as an adjunct to intensive out-patient drug abuse counseling. Retention in treatment at 90 days was compared to data from a control group of 80 subjects who had received 10 mg of imipramine per day in an earlier trial. Median retention was 17 days in both groups. No side effects were reported by the subjects receiving tyrosine. These results do not support the utility of tyrosine in the treatment of cocaine dependence.

Safe withdrawal from acute alcohol abuse in the aged.

It is imperative to consider chronic and acute alcoholism as possibly underlying problems that aged persons may exhibit. The potential exacerbation of organ dysfunctions, the complexity of medication regimens, and negative interactions of these are all more likely to create problems in the treatment of the elderly alcoholic patient. The nurse, the social worker, the nutritionist, the physician, and the pharmacologist must work as a team to treat these patients properly. The nurse focuses on maintaining patient safety and function, continually assessing, observing, and reassessing. On the basis of these data the pharmacologist collaborates with the physician to manage medications and titrate dosages properly. Malnutrition is a prevalent problem among the aged, particularly older alcoholic men who live alone. The nutritionist must assess dietary deficiencies and recommend therapeutic vitamins, minerals, and foods as needed. It is imperative to evaluate serum levels of folic acid, cyanocobalamin, thiamine, magnesium, and to monitor periodically potassium. Before discharge the social worker assists the patient in beginning an appropriate alcoholic treatment plan. The situation of the acutely ill alcoholic patient requires ongoing and precise collaboration of the team to achieve acceptable outcomes.