From the Guidelines
The acute effects of cocaine typically last between 15 to 90 minutes, depending on the method of administration, with snorting lasting about 60-90 minutes and smoking or injecting lasting only 5-15 minutes. When considering the management of patients with cocaine-associated chest pain, it is essential to prioritize their morbidity, mortality, and quality of life. According to the guidelines, patients with signs of acute cocaine intoxication should not be administered beta blockers due to the risk of potentiating coronary spasm 1.
Key Factors Affecting Duration
- Method of administration: snorting, smoking, or injecting
- Purity of the cocaine
- Individual metabolism
- Tolerance level
- Consumption of other substances simultaneously
The effects of cocaine on the cardiovascular system can precipitate acute coronary syndromes, and treatment should be tailored to the individual patient's risk factors and symptoms 1. Benzodiazepines alone or in combination with nitroglycerin have been useful for management of hypertension and tachycardia owing to their effects on the central and peripheral manifestations of acute cocaine intoxication. Physiologically, cocaine blocks the reuptake of neurotransmitters like dopamine, norepinephrine, and serotonin, creating intense euphoria, increased energy, and alertness, which diminish as the drug is metabolized by the body 1.
Management of Cocaine-Associated Chest Pain
- Risk stratification based on ECG changes and positive cardiac troponin
- High-risk patients should be admitted to monitored beds
- Intermediate- and low-risk patients can be safely managed in a chest pain observation unit for 9 to 12 hours
- Stress testing can be performed at the time of observation or on an outpatient basis, depending on cardiac risk factors and ongoing symptoms 1
From the Research
Acute Effects of Cocaine
The acute effects of cocaine are numerous and can involve several organ systems, resulting from a limited number of cocaine-protein interactions, including monoamine transporters, neurotransmitter receptors, and voltage-gated ion channels 2. These interactions trigger a cascade of events that produce the clinical effects of cocaine.
Duration of Acute Effects
- The studies provided do not specify the exact duration of the acute effects of cocaine.
- However, it is known that upon acute administration, cocaine increases blood pressure and heart rate, primarily through an action on the sympathetic nervous system, and these effects can lead to cardiac ischemia and other cardiovascular issues 3.
- The effects of cocaine mediated by the sympathetic nervous system are greatly reduced in anesthetized animals, and acute tolerance can develop to the sympathomimetic effects of cocaine when administered repeatedly over a short period of time 3.