The treatment rationale for dopamine agonists or dopamimetics is to increase dopamine concentrations to overcome the dopamine depletion that has been theorised to underlie psychostimulant craving and withdrawal.

Pergolide mesylate, which is used in the treatment of Parkinson's disease, is more potent, has a longer duration of action than bromocriptine and has been suggested to have a more favourable side-effect profile. However, a large (N=255 cocaine users) five-year study of pergolide mesylate, found that subjects receiving placebo had significantly better retention and treatment outcomes (Malcolm, Herron, Sutherland & Brady, 2001). This outcome may be due to pergolide mesylate increasing cocaine craving (Fischman & Foltin, 1998). As cardiovascular complications are potentially the most serious side-effects of pergolide mesylate, Malcolm, Moore, Kajdasz and Cochrane (1997) recommend baseline screening, a cautious approach and close monitoring of users with current or past heart disease who are prescribed the drug.

A recent systematic review (Soares, Lima, Reisser & Farrell, 2002) found that current evidence does not support the clinical use of dopamine agonists in the treatment of cocaine dependence. This review identified 12 studies, most of which compared amantadine or bromocriptine to placebo. The main efficacy outcome presented was positive urine sample for cocaine metabolites, with no significant differences between interventions. Rates of retention in treatment were also similar in both placebo and active drugs. A recent study of amantadine for cocaine dependence (Shoptaw, Kintaudi, Charuvastra & Ling, 2002) found no significant difference in cocaine abstinence at the end of 16 weeks of treatment among 69 patients. Bromocriptine is associated with nausea, headache, orthostatic hypotension and psychotogenic effects (Sevarino et al., 2000; Tutton & Crayton, 1993).