Antidote for Cocaine?

[OVeractiveBrain]

A resident mentioned that there is an acute antidote for acute cocaine toxicity (being SOB, CP, N/V, elevated heart rate). I didn't quite believe them, but just because I haven't heard of something doesn't mean it doesnt exist.

The only thing I could find is dynorphin, which new studies show might prevent the pleasurable, and dangerous, effects of cocaine. The study was more aimed at preventing addiction and not-so-acute effects.

So...anyone heard of a legitimate treatment for acute cocaine toxicity? I know we can treat some of the symptoms or use what tools we have to maintain stability. Thats not what Im asking. Anyone who has any knowledge or potent links to an antidote (even a treatment) for a cocaine OD, it would be much appreciated.

[SARgal]

Ran a google search and the second item was this:

http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract

Nitrendipine: an antidote to cardiac and lethal toxicity of cocaine.

* Trouve R,

* Nahas G.

Nitrendipine, a Ca2+ modulator was tested in the rat as an antagonist to the cardiac toxicity of cocaine and as an antidote to the acute lethal effects of this drug. In a first series of experiments, nitrendipine (1.46 X 10(-3) mg/kg/min) when simultaneously administered intraarterially with cocaine (2 mg/kg/min) suppresses the arrhythmias induced by cocaine and increases survival time from 73 +/- 33 min to 309 +/- 118 min and the lethal dose of cocaine from 146 +/- 66 mg/kg to 618 +/- 236 mg/kg (p less than 0.003). Nitrendipine also protects the heart from the acute morphological lesions induced by cocaine administration and antagonizes some of the central effects of cocaine. In a second series, 5 rats administered 60 mg/kg of cocaine intraperitoneally had a survival time of 8'06 +/- 5'20. Death was attributed to convulsions and respiratory arrest. Animals treated with nitrendipine (129 +/- 23 mg/kg) 4'30" after cocaine administration survived. Nitrendipine appears to have general protective effects against cocaine cardiac toxicity and the acute lethal effects of this alkaloid.

PMID: 3797422 [PubMed - indexed for MEDLINE]

[AZCEP]

The best treatment for a sympathomimetic overdose is still long acting benzodiazepines, and altering absorption.

The calcium channel blocker would control cardiac output, but do nothing for the CNS effects.

[Ridryder 911]

I have never seen Nitrendipine used in ED, I agree the best resource appears to be Valium to relax, many will produce into a coronary spasm AMI

R/r 911

[scratrat]

I have heard of beta blocker use but I also remember something about sodium bicarb. I could be wrong but I swear I remember hearing something about that? Maybe...anyone else know?

[chbare]

Scratrat, beta blockers are generally not used in cocaine induced cardiac ischemia/injury. Vasospasm is a concern with the cocaine MI patient and beta blockers may block your beta receptors and allow for an unopposed alpha response. Unfortunately, arterial constriction is controlled via alpha receptors, and this may lead to worsened coronary vasospasm.

Take care,

chbare.

[scratrat]

Sorry, I meant to say calcium channel blockers. I messed that one up..

[fiznat]

I think there are probably two ways to ask this question:

1. Do cocaine antidotes exist

2. Are there cocaine antidotes currently in use on a large scale

The answer to 1 is, as others have posted, yes. To 2, though, the answer is no. I asked our medical control doc about this one a few weeks back and was given this same answer. There are a few ideas that are currently being tested, but nothing that really falls under the standard of care.

Come back to the East Coast Dustyn. We prefer heroin in these parts, which is much easier to treat .