Cocaine intoxication - NYSORA

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Cocaine intoxication

Learning objectives

  • Diagnose and treat cocaine toxicity

Definition and mechanisms

  • Cocaine intoxication refers to the subjective, desired and adverse effects of cocaine on the mind and behavior of users
  • Cocaine has an indirect sympathomimetic effect 
  • It is often mixed with adulterants which can cause health problems on their own
  • The drug was the first local anesthetic discovered
  • Cocaine is available in two forms – the hydrochloride (white powder) and free-base (‘crack’ cocaine) made by combining the hydrochloride and an alkali
  • Intranasal or intravenous administration results in rapid euphoria and a sensation of power and tirelessness
  • In higher doses, agitation, insomnia, hallucinations, and seizures may occur
  • These effects are mediated by an increase in catecholamines acting at central receptors, but peripheral effects of sympathetic stimulation (e.g. raised heart rate and blood pressure) are also prominent
  • The main danger in an overdose are cardiovascular complications
  • Levamisole is an anti-anthelmintic agent found in up to 70% of cocaine samples and can cause agranulocytosis and vasculitis

Signs and symptoms

CardiovascularTachycardia and hypertension
Arrhythmia and cardiac conduction abnormalities
Acute coronary syndromes: vasospastic and /or coronary thrombotic
QT prolongation
Aortic dissection
Anxiety, dysphoria, agitation, and aggression
Paranoid psychosis
Hyperthermia, rigidity and myoclonic movements
Depression, sometimes with tentamen suicide
RespiratoryPulmonary edema
Peripheral sympathomimetic
Muscle fasciculations
Mydriasis, sweating and tremor
OtherHyperthermia induced rhabdomyolysis, renal failure, and cerebral edema
Subarachnoid/intracerebral hemorrhage
Ischemic colitis
Ileus (body packers)


Cocaine intoxication, benzodiazepines, hyperthermia, ice packs, body packing, activated charcoal, polyethylene glycol, nitrates, aspirin, angor, serotonin syndrome

Suggested reading

  • Kramers C. et al. Toxicologische behandel informatie: Cocaïne, 2020, accessed 25/01/2023,
  • Nicholson Roberts, T., Thompson, J.P., 2013. Illegal substances in anaesthetic and intensive care practices. Continuing Education in Anaesthesia Critical Care & Pain 13, 42–46.
  • Jenkins BJ. 2002. Drug abusers and anaesthesia, BJA CEPD Reviews. 2;1:15-19.

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