Chapter 66 – Biperiden in the Treatment of Cocaine/Crack Dependence: Clinical Perspectives

Even though dopamine plays a central role in the reward system, other neurotransmitters are involved in the search for reinforcement. Cholinergic and dopaminergic systems together seem to coordinate the reinforcing function underlying drug consumption and addiction. Preclinical models including neurochemical and behavioral studies have shown effects of cholinergic agonists and antagonists on cocaine reinforcement. Recently, a double-blind placebo-controlled randomized study showed that biperiden (a muscarinic antagonist) in addition to enhancing adherence to psychological therapy also reduced cocaine/crack craving and consumption. These results might be related to the cholinergic blockade that regulates the dopaminergic circuit in the nucleus accumbens and interferes with the learning processes and memory impairment by the administration of biperiden. This damage could have a beneficial effect by dissociating the rewarding effects from the context.