Flupentixol-Induced Aversion to Crack Cocaine

To the Editor: Disulfiram causes an aversive response to alcohol that is used therapeutically to foster abstinence. There is no similarly effective and safe aversive treatment for cocaine abuse. We report here that flupentixol decanoate can cause transient, severely distressing, involuntary muscular restlessness and movement (akathisia) after crack-cocaine smoking that is associated with the subsequent cessation of crack use. Flupentixol is a neuroleptic at high plasma concentrations but has nonneuroleptic, antidepressant activity at low concentrations, 1 a characteristic that provides the basis for its use in treating cocaine craving and abuse. In injectable depot form, it has a duration of action . . .