Cardiovascular Complications of Cocaine Use

Lange, Richard A.; Hillis, L.David

doi:10.1056/nejm200108023450507

Cited by 715 publications

(503 citation statements)

References 74 publications

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“…The sudden death related to cocaine use may be due to cardiac etiologies [31]. Nearly every type of dysrhythmia has been reported with cocaine use, [4] and it stands to reason that sudden death related to cocaine could be due to lethal dysrhythmias. Ventricular dysrhythmias are a well-recognized complication of myocardial infarction, and ventricular dysrhythmias certainly occur in the setting of cocaine-induced myocardial ischemia [32].…”

Section: Cocainementioning

confidence: 99%

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The effect of amiodarone pretreatment on survival of mice with cocaine toxicity

et al. 2005

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Introduction: Cocaine is a common drug of abuse and use has been associated with ventricular dysrhythmias. Published guidelines suggest that amiodarone is the first line antidysrhythmic for ventricular tachycardia and fibrillation. However, the effects amiodarone in the setting of cocaine toxicity are unknown and unstudied. The purpose of this study was to evaluate the safety and efficacy of amiodarone pretreatment in a murine model of acute cocaine toxicity.Methods: This was a randomized, blinded, placebo controlled investigation using male CF-1 mice weighing 29-37 g. First, the safety of an intraperitoneal dose of amiodarone (40 mg/kg) was confirmed in 5 mice. Second, based on preliminary investigations, an approximate intraperitoneal LD 50 dose of cocaine (110 mg/kg) was identified and used as the cocaine dose in this study. Animals were then randomized to 2 groups. The control group received 0.5 mL of intraperitoneal 0.9% saline 30 minutes before cocaine. The study group received 40 mg/kg of intraperitoneal amiodarone (40 mg/kg) 30 minutes before cocaine. A blinded observer monitored mice for 2 hours after cocaine administration.Results: No mice in the amiodarone-only group developed any signs of toxicity or died. In the saline ϩ cocaine group 31/32 (96.9%; 95% CI 83.8 to 99.9) mice seized with a median time to seizure of 2.5 minutes, and 23/32 (71.9%; 95% CI 52.3 to 86.3) died with a median time to death of 5.5 minutes. In the amiodarone ϩ cocaine group 31/33 (93.9%; 95% CI 79.0 to 99.3) mice seized with a median time to seizure of 2.0 minutes, and 24/33 (72.7%; 95% CI 54.5 to 86.7) died with a median time to death of 6.0 minutes. All animals that died did so within 9 minutes. The difference in the proportion of animals dying in the amiodarone ϩ cocaine group compared to the saline ϩ cocaine group was 0.008 (Ϫ21 to 22%).Conclusions: In this study, pretreatment with amiodarone in cocaine poisoned mice resulted in no change in seizure incidence or mortality. However, definite conclusions about the reason for these findings cannot be drawn from this model.

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Section: Cocainementioning

confidence: 99%

“…Numerous acute medical problems have been associated with cocaine abuse, including cardiac dysrhythmias [2][3][4][5][6][7]. Although the etiology of cocaine-associated dysrhythmias is complex and not fully understood, lethal ventricular dysrhythmias are a theorized cause of sudden death associated with cocaine use [8].…”

Section: Introductionmentioning

confidence: 99%

The effect of amiodarone pretreatment on survival of mice with cocaine toxicity

et al. 2005

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“…Despite decades of effort, no effective useful antagonists of cocaine reinforcing or toxic effects are available (8,(10)(11)(12). This failure is due to the cocaine mechanism of action as a competitive blocker of neurotransmitter re-uptake, particularly of dopamine, norepinephrine, and serotonin.…”

Section: Introductionmentioning

confidence: 99%

The Rhodococcus sp. Cocaine Esterase: A Bacterial Candidate for Novel Pharmacokinetic‐based Therapies for Cocaine Abuse

2003

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SummaryCocaine is a powerful central nervous stimulant and among the most abused of drugs. Despite decades of efforts, however, no effective pharmacological treatments are available against cocaine addiction or toxic effects. Classical receptor-antagonist therapeutic approaches have not yielded significant effects, although cocaine targets are well known, thus fostering development of alternative therapeutic strategies. Recent evidence indicates that a sensible approach for treatment of cocaine abuse could be to interfere with cocaine pharmacokinetics, i.e. by preventing the drug from reaching the receptors responsible for its biological effects. Administration of cocaine binding antibodies as well as catalytic antibodies and enzymes that hydrolyze cocaine represent potential alternative therapeutic approach(es). The discovery of the cocaine esterase from the strain MB1 of the bacterium Rhodococcus sp. (cocE) could be a major breakthrough in this field; cocE hydrolyzes cocaine faster than any known cocaine esterase and catalytic antibody. IUBMB Life, 55: 397-402, 2003 Keywords Rhodococcus sp. esterase; human plasma butyrylcholinesterase; human liver carboxylesterase-1; human liver carboxylesterase-2; cocaine binding antibodies; cocaine binding catalytic antibodies; cocaine metabolism.

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“…1 Among patients with addiction to multiple substances, the combination of cocaine and ethanol is the most common. 6 This article will review the epidemiology, pathophysiology, clinical symptomatology, interactions with pregnancy, and obstetric, anesthetic, and medicolegal implication of cocaine use, and abuse in pregnancy. 1 1. .…”

mentioning

confidence: 99%

“…1,5,17,26 Concomitant abuse of several substances is very common. 1, [4][5][6]17,26,28 Among those with abuse of multiple substances; the combination of cocaine and ethanol is the most common. 4,6 The combined use of cocaine and ethanol appears to be associated with higher rates of complications, including death, than either drug used alone.…”

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confidence: 99%

The cocaine abusing parturient: a review of anesthetic considerations

Kuczkowski

2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The prevalence of recreational drug abuse among young women, including in pregnancy, has increased markedly over the past two decades. Cocaine remains the drug commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anesthetic management of pregnant patients with a history of cocaine abuse.S So ou ur rc ce e: : A Medline search for articles highlighting drug abuse in pregnancy, with particular emphasis on cocaine abuse in pregnancy, the drug's impact on the fetus and implications for administration of obstetrical anesthesia was performed.M Ma ai in n f fi in nd di in ng gs s: : Because the pharmacological actions of cocaine are complex, the clinical picture can be very unpredictable, the diagnosis often difficult, and management at times controversial. The diverse clinical symptomatology of cocaine intake combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy specific disease may lead to life-threatening complications and significantly impact the management of obstetrical anesthesia.C Co on nc cl lu us si io on ns s: : In the absence of uniform anesthetic guidelines for pregnant patients with a history of cocaine abuse the decision regarding the administration of peripartum analgesia or anesthesia should be individualized and conducted on a case-by-case basis. This article will attempt to heighten the awareness of cocaine use and abuse in pregnancy and review the perioperative anesthetic management of these high-risk parturients. Objectif : La prévalence d'abus occasionnel de drogues par les jeunes femmes, incluant les femmes enceintes, a beaucoup augmenté pendant les deux dernières décennies. La cocaïne est la

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Cardiovascular Complications of Cocaine Use

Cited by 715 publications

References 74 publications

The effect of amiodarone pretreatment on survival of mice with cocaine toxicity

The effect of amiodarone pretreatment on survival of mice with cocaine toxicity

The Rhodococcus sp. Cocaine Esterase: A Bacterial Candidate for Novel Pharmacokinetic‐based Therapies for Cocaine Abuse

The cocaine abusing parturient: a review of anesthetic considerations

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