Cocaine intoxication may be caused by:

• Taking too much cocaine, or taking a too-concentrated a form of cocaine
• Using cocaine when the weather is hot, which leads to more harm and side effects due to dehydration
• Using cocaine with certain other drugs

Symptoms of cocaine intoxication include:

• Feeing high, excited, talking and rambling, sometimes about bad things happening
• Anxiety, agitation, restlessness, confusion
• Muscle tremors, such as in the face and fingers
• Enlarged pupils that don't get smaller when a light shines into the eyes
• Increased heart rate and blood pressure
• Lightheadedness
• Paleness
• Nausea and vomiting
• Fever, sweating

With higher doses or an overdose, more severe symptoms can occur, including:

• Seizures
• Loss of awareness of surroundings
• Loss of urine control
• High body temperature, severe sweating
• High blood pressure, very fast heart rate or irregular heart rhythm
• Bluish color of the skin
• Fast or difficulty breathing
• Death
  

Cocaine is often cut (mixed) with other substances. When taken, additional symptoms can occur.

If cocaine intoxication is suspected, the health care provider may order the following tests:

• Cardiac enzymes (to look for evidence of heart damage or heart attack)
• Chest x-ray
• CT scan of the head, if head injury or bleeding is suspected
• ECG (electrocardiogram, to measure electrical activity in the heart)
• Toxicology (poison and drug) screening
• Urinalysis

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Symptoms will be treated as appropriate. The person may receive:

• Breathing support, including oxygen, a tube down the throat, and ventilator (breathing machine)
• IV fluids (fluids through a vein)
• Medicines to treat symptoms such as pain, anxiety, agitation, nausea, seizures, and high blood pressure
• Other medicines or treatments for heart, brain, muscle, and kidney complications

Long-term treatment requires drug counseling in combination with medical therapy.

The outlook depends on the amount of cocaine used and what organs are affected. Permanent damage may occur, which may cause:

• Seizures, stroke, and paralysis
• Chronic anxiety and psychosis (severe mental disorders)
• Decreased mental functioning
• Heart irregularities and decreased heart function
• Kidney failure requiring dialysis (kidney machine)
• Destruction of muscles, which can lead to amputation

Intoxication - cocaine

Aronson JK. Cocaine. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:492-542.

Chary MA, Erickson TB. Cocaine and other sympathomimetics. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 144.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.