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Cocaine Facts

Stimulant; Substituted tropane; Dopamine reuptake inhibitor

Description

Cocaine — coke, blow, snow — is a stimulant of the tropane alkaloid class. It blocks the brain's recycling of dopamine, norepinephrine, and serotonin simultaneously,[1] producing intense, brief euphoria.

Subjective effects include euphoria, confidence, accelerated thought, talkativeness, and heightened cardiovascular arousal. The experience is defined by its abruptness — an intense peak that drops steeply into restless dysphoria, producing a sharper comedown arc than any commonly used stimulant.

Cocaine produces low physical but high psychological dependence; cardiovascular toxicity is the primary cause of cocaine-related death.[2] Blood levels cannot predict lethality — chronic use builds cumulative cardiac damage that lowers the threshold for fatal arrhythmia, and individual genetics dramatically alter risk.[3]

Dose and durationby route · individual sensitivity varies

Oral(mg)
Threshold< 20 mgLight30 – 60 mgCommon60 – 120 mgStrong120 – 180 mgHeavy180+ mg

Starts in 30 – 40 minLasts 120 – 240 minAfter-effects 1 – 3 hours

Body and dependence

Acute toxicity
High
Chronic toxicity
High
Physical dependence
Low
Psychological dependence
High
Withdrawal
Moderate
Compulsive redosing
High

Tolerance

Builds
Rapid
Fully resets after
14 days
Carries over to
amphetamine; methamphetamine; methylphenidate

Effectslikely at a common dose

Perception
none likely · 5 possible
Body
Appetite suppression; Pupil dilation; Vasoconstriction; Wakefulness; Stimulation; Body high; Insomnia; +21 possible, including Dehydration sensation, Heart rate perception changes, Temperature dysregulation
Thinking
Compulsive redosing urge; Cognitive euphoria; Thought acceleration; Cognitive fatigue; +16 possible, including Cognitive dysphoria, Decision impairment, Cognitive impairment
Feeling
Euphoria; +8 possible, including Anxiety, Depression, Anhedonia
Self
Craving; +4 possible, including Ego inflation
Time
none likely · 1 possible
Awareness
none likely · 1 possible

Who shouldn't take it

Absolute
Long QT syndrome; Coronary artery disease; Concurrent beta-blocker therapy; Cerebrovascular disease; Psychotic disorders; Pregnancy
Relative
Hypertension; Hepatic impairment; Renal impairment

Combinations68 recorded

Lethal (9)
2-Aminoindane; 2-FEA; Ibogaine; MCPP; MDEA; Methylnaphthidate; Opioids; Tramadol; αMT
Dangerous (39)
Amphetamines; Benzodiazepines, Barbiturates; Ephedrine, Pseudoephedrine; Local anesthetics; MAOIs; MDMA, Amphetamines; MDMA, MDA; NDRIs (Wellbutrin); Nicotine; NRIs; SSRIs; Stimulants; 5-HTP, Tryptophan; Alpha-2 adrenergic receptor antagonist; Anticholinergics; Antihistamines; Antipsychotics; Atypical antipsychotics; Buspirone; Caffeine; Clonidine, Guanfacine; Dopamine agonists; DXM; GHB, Baclofen; and 15 more, see full page
Caution (17)
See full page: psychedex.org/substances/cocaine
Not graded (3)
Not listed never means safe.

Seek help immediately if

  • Chest pain; racing, pounding, or irregular heartbeat
  • Very high body temperature; heavy sweating; hot, flushed skin
  • Severe agitation, paranoia, panic, or confusion
  • Severe headache; muscle rigidity or twitching
  • Seizures
  • Signs of stroke — face drooping, one-sided weakness, slurred speech
  • Difficulty breathing; collapse or unconsciousness

What to do

  1. Call emergency services for chest pain, overheating, seizure, or unresponsiveness
  2. Move them to a cool, quiet place and reduce stimulation
  3. Cool the body — remove excess clothing, apply cool damp cloths, fan them
  4. Keep them calm; reassure — panic worsens the cardiovascular strain
  5. If seizing, protect from injury (don't restrain); recovery position afterward
  6. Monitor breathing and be ready to give rescue breaths / CPR

Most stimulant overdoses settle with cooling, a calm environment, and time. The medical danger is hyperthermia, cardiac events (arrhythmia, heart attack, stroke), and seizures — get help immediately if any appear.

988 Suicide & Crisis LifelineFireside Project: 62-FIRESIDE

Version r1 · Not medical advice

References

  1. [1]
    ^Han DD, Gu HH (2006) Comparison of the monoamine transporters from human and mouse in their sensitivities to psychostimulant drugs — BMC Pharmacology PMID:16515684
  2. [2]
    ^Billman GE (1995) Cocaine cardiotoxicity: toxic mechanisms of the heart — Critical reviews in toxicology PMID:7612173
  3. [3]
    ^Karch SB (2005) Cocaine cardiovascular toxicity — Southern medical journal PMID:16144174
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