What is the treatment for cocaine overdose?

From the Guidelines

Cocaine overdose treatment should prioritize immediate medical attention, focusing on stabilizing vital signs and addressing cardiovascular issues, with benzodiazepines and vasodilators being key components of management, as recommended by the 2023 American Heart Association guidelines 1. The primary goal in treating cocaine overdose is to reduce the risk of morbidity, mortality, and improve quality of life by managing the drug's toxic effects on the cardiovascular system.

• Key considerations in management include:
  • Addressing hyperthermia with evaporative or immersive cooling modalities, as these methods reduce temperature more rapidly than other cooling techniques 1
  • Using benzodiazepines such as diazepam (5-10mg IV) or lorazepam (2-4mg IV) to reduce agitation, seizures, and cardiovascular stimulation
  • Administering vasodilators like phentolamine, nitrates, or verapamil to improve coronary blood flow and myocardial oxygen delivery in patients with cocaine-induced coronary vasospasm 1
  • Considering the use of lidocaine to reverse cocaine-induced QRS prolongation, although human evidence is limited to case reports and small retrospective studies 1
  • Avoiding the use of β-blockers due to controversy surrounding their safety in treating life-threatening cardiovascular toxicity from cocaine 1
• Additional measures may include:
  • Activated charcoal administration if the cocaine was recently ingested orally
  • Intravenous fluids to help with hydration and kidney function
  • Monitoring for complications and potential psychiatric evaluation after stabilization
• It is crucial to note that cocaine overdose can lead to life-threatening complications, including heart attack, stroke, and respiratory failure, due to the drug's effect on the sympathetic nervous system, emphasizing the need for prompt and effective treatment 1.

From the Research

Treatment for Cocaine Overdose

• The treatment for cocaine overdose involves addressing the associated symptoms and complications, such as seizures, acidosis, and cardiovascular toxicity 2, 3, 4.
• Initial management involves standard life-support measures, and therapeutic agents are given as appropriate to control acute reactions and counteract continuing toxicity 3.
• Benzodiazepines and other GABA-active agents may be used to treat seizures and agitation, but may not always effectively mitigate tachycardia, hypertension, and vasospasm from cocaine toxicity 4.
• Calcium channel blockers may decrease hypertension and coronary vasospasm, but not necessarily tachycardia 4.
• Nitric oxide-mediated vasodilators, such as nitroglycerin, may lead to severe hypotension and reflex tachycardia 4.
• Alpha-adrenoceptor blocking drugs, such as alpha-1 blockers, may improve hypertension and vasospasm, but not tachycardia 4.
• Beta-blockers and β/α-blockers, such as labetalol and carvedilol, may be effective in attenuating both hypertension and tachycardia 4.
• Antipsychotics may improve agitation and psychosis, but with inconsistent reduction in tachycardia and hypertension and risk of extrapyramidal adverse effects 4.
• Other agents, such as morphine, lidocaine, sodium bicarbonate, amiodarone, procainamide, propofol, intravenous lipid emulsion, and ketamine, may also be used in the treatment of cocaine overdose 4.

Importance of Early Intervention

• Early intervention is critical in the treatment of cocaine addiction, and accurate assessment of medical, behavioral, and psychosocial variables is crucial 5.
• The ability of health care professionals to intervene early in the disease progression is critical, and yields a less guarded treatment prognosis 5.
• Medical science has used existing strategies and new regimens to assist in the management of cocaine "craving," but these strategies alone will not be effective without the time-tested delivery of rehabilitative services synergistically applied with self-help programs 5.

Recognition and Management of Cocaine Overdose

• Primary care physicians should be aware of the symptoms of cocaine overdose and know how to recognize and manage them, as the reaction may progress rapidly to a fatal outcome 6.
• The presentation and treatment of acute cocaine intoxication requires a comprehensive approach, involving medical, behavioral, and psychosocial interventions 6.