Cocaine Dosage Guide

Cocaine overdose is a medical emergency with no antidote. Unlike opioid overdose, there is no naloxone equivalent — treatment is entirely supportive. The primary life-threatening complications are cardiovascular: myocardial infarction, stroke, aortic dissection, and fatal arrhythmias. These can strike young, healthy individuals at doses previously tolerated. In 2023, nearly 30,000 US overdose deaths involved cocaine — about 28% of all drug overdose fatalities. ## Recognizing Overdose Warning signs: severe chest pain or pressure, irregular or extremely rapid heartbeat, difficulty breathing, extreme agitation, seizures, dangerously high body temperature, confusion, bluish skin (cyanosis), and loss of consciousness. A heart attack may present as crushing chest pain radiating to the arm or jaw, shortness of breath, and nausea. ## What to Do **Call 911 immediately.** Good Samaritan laws apply in most jurisdictions. While waiting: - Keep the person calm and still — exertion increases cardiac strain - If seizing, protect their head; do not restrain or put anything in their mouth - If unconscious and not breathing, begin CPR - If overheating, apply cool cloths to neck, armpits, and groin - If fentanyl contamination is possible, administer naloxone if available — it will not help cocaine toxicity but could save a life if fentanyl is involved ## Hospital Treatment **Benzodiazepines** are first-line for agitation, seizures, and cardiovascular symptoms. **Beta-blockers are generally avoided** — they risk unopposed alpha-adrenergic stimulation that can worsen hypertension. Aspirin is given for suspected cardiac events; nitroglycerin for chest pain. Hyperthermia is treated with external cooling. The AHA recommends standard ACLS protocols. **Any chest pain during or after cocaine use should be taken seriously** — cardiac risk remains elevated for hours after the last dose.