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Cocaine intoxication refers to the immediate effects of cocaine on the body. Although cocaine intoxication and cocaine dependence can be present in the same individual, they present with different sets of symptoms.
Signs and symptoms
Cocaine increases alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality. Common side effects include anxiety, increased temperature, paranoia, restlessness, and tooth grinding. With prolonged use, often accompanied by lack of sleep, the drug can cause itching, tachycardia, hallucinations, and paranoid delusions. Possible lethal side effects include rapid heartbeat, tremors, convulsions, markedly increased core temperature, heart attack, stroke and heart failure.
Depression with suicidal ideation may develop in very heavy users. Finally, a loss of vesicular monoamine transporters, neurofilament proteins, and other morphological changes appear to indicate a long-term damage to dopamine neurons. Chronic intranasal usage can degrade the cartilage separating the nostrils (the septum nasi), which can eventually lead to its complete disappearance.
Physical withdrawal is not dangerous; however, physiological changes caused by cocaine withdrawal include vivid and unpleasant dreams, insomnia or hypersomnia, anger, increased appetite and psychomotor retardation or agitation.
Most deaths due to cocaine are accidental. Use of cocaine causes tachyarrhythmias and a marked elevation of blood pressure, which can be life-threatening. This can lead to death from respiratory failure, stroke, cerebral hemorrhage, or heart-failure. Cocaine is also highly pyrogenic, because the stimulation and increased muscular activity cause greater heat production. Heat loss is inhibited by the intense vasoconstriction. Cocaine-induced hyperthermia may cause muscle cell destruction and myoglobinuria resulting in renal failure. Emergency treatment often consists of administering a benzodiazepine sedation agent, such as diazepam (Valium) to decrease the elevated heart rate and blood pressure. Physical cooling (ice, cold blankets, etc...) and paracetamol (acetaminophen) may be used to treat hyperthermia, while specific treatments are then developed for any further complications. There is no officially approved specific antidote for cocaine overdose, and although some drugs such as dexmedetomidine and rimcazole have been found to be useful for treating cocaine overdose in animal studies, no formal human trials have been carried out. In addition, a history of high blood pressure or cardiac problems puts the patient at high risk of cardiac arrest or stroke, and requires immediate medical treatment. According to the Centers for Disease control, approximately 5000 deaths occur annually in the US due to cocaine overdose.
Labetalol is the only known β blocker that is safe to use in patients with cocaine overdose due to the fact that unlike other β-blockers, it also inhibits α1 receptors. However, data from clinical trials suggest that labetalol is no better than placebo. Taken as a whole, evidence suggests that beta antagonists are absolutely contraindicated in the treatment of cocaine toxicity.
Cocaine's primary acute effect on brain chemistry is to raise the amount of dopamine and serotonin in the nucleus accumbens (the pleasure center in the brain); this effect ceases, due to metabolism of cocaine to inactive compounds and particularly due to the depletion of the transmitter resources (tachyphylaxis). This can be experienced acutely as feelings of depression, as a "crash" after the initial high. Further mechanisms occur in chronic cocaine use.
The chest pain, high blood pressure, and increased heart rate caused by cocaine may be treated with benzodiazepine. If this is not enough to reduce the blood pressure, intravenous sodium nitroprusside or nitroglycerin may be used.
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