Cocaine
Benzoylmethylecgonine (stimulant)
Called 'the perfect heart-attack drug' — deadly even once.
Banned / Harmful evidence
☠️Banned & Harmful
Evidence tier
Banned / Harmful
Research weight
Not supported
Citations
21 verified / 21
Classification
Banned & Harmful
⊘
What the evidence says. Linked to serious harm and/or banned in sport and many jurisdictions. Listed for awareness and safety only — NOT a recommendation.
⚠
Health warning. Cocaine can cause a heart attack, stroke, seizure or sudden death even on a first use, at any dose. It is intensely addictive, often contaminated with fentanyl, and has no safe level of use. Listed purely for harm-awareness.
What is Cocaine?
Cocaine (Benzoylmethylecgonine (stimulant)) is a banned or harmful substance marketed for brief euphoria, energy and alertness — lasting minutes, followed by a crash and craving. NutriDex grades the human evidence as Banned / Harmful. Cocaine is a powerful stimulant that spikes heart rate and blood pressure while constricting the vessels feeding the heart — a combination cardiologists have called 'the perfect heart-attack drug'. Damage can occur from the very first use, and it sharply raises the risk of both ischemic and hemorrhagic stroke, including in otherwise-healthy young users. It is highly addictive, and the illicit supply is increasingly contaminated with fentanyl, adding overdose risk. This entry exists to warn, not to inform use.
Marketed Claims (unproven)
✕Brief euphoria, energy and alertness — lasting minutes, followed by a crash and craving
Dosing & Compounds
Use & Legality
No safe dose. Illegal controlled substance — any amount can be fatal.
Active Compounds
Safety & Cautions
⚠ EXTREME HARM. Heart attack, stroke, fatal arrhythmia, seizure and sudden death — possible on a first use. Highly addictive. Damages the heart, brain and nasal tissue; pregnancy harm; psychosis and paranoia. The illicit supply is frequently laced with fentanyl, causing unintentional opioid overdose. Illegal. Educational only — always check with your doctor or pharmacist before combining Cocaine with any medicine.
Evidence & Risk Findings ★ 21 studies
systematic review
van Amsterdam et al., J Clin Med 2024
✓ PubMed
Systematic review found combined cocaine + alcohol use produces cocaethylene, associated with an 18- to 25-fold higher risk of sudden death versus cocaine alone, and higher cardiovascular mortality.
systematic review
Predictors of CUD treatment outcomes, Syst Rev 2024
✓ PubMed
Systematic review of 32 RCTs identified younger age, longer cocaine use history, and higher craving as predictors of relapse/dropout; each additional year of use cut odds of a negative urine sample at 9 months by ~5%.
Systematic review
Alcohol + cocaine cardiovascular risk review (J Clin Med 2024)
✓ Full text
Systematic review of 42 studies found combined cocaine-alcohol use forms cocaethylene, associated with an 18-25 fold higher risk of acute cardiac death versus cocaine alone via inhibition of cardiac ion channels.
Meta-analysis
Rendon et al. 2023 (J Clin Med)
✓ PubMed
Systematic review/meta-analysis (36 studies): cocaine use increased the odds of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage roughly 5-fold (pooled OR 5.05, p<0.001), and among stroke patients cocaine use raised odds of mortality (OR 1.77), vasospasm (OR 2.25), and seizures (OR 1.61); strokes occurred in younger, disproportionately African American patients.
Meta-analysis
Peacock et al. 2020 (Addiction)
✓ PubMed
Systematic review/meta-analysis of 21 cohorts (170,019 people with regular/problematic cocaine use): pooled all-cause standardized mortality ratio (SMR) 6.13 (95% CI 4.15-9.05) vs general population, with markedly elevated cause-specific SMRs for homicide (9.38), accidental injury (6.36), suicide (6.26), and AIDS-related death (23.12).
Meta-analysis
Arenas et al. 2020 (Sci Rep)
✓ PubMed
Systematic review/meta-analysis on cocaine, cardiomyopathy, and heart failure: chronic cocaine use is associated with structural/functional cardiac changes more consistent with diastolic (not the classically taught dilated) heart failure; in patients without prior acute coronary syndrome it was not associated with significantly reduced ejection fraction, and beta-blocker therapy appeared safe and potentially beneficial.
Meta-analysis
Makarious et al. 2022 (Arch Dis Child Fetal Neonatal Ed)
✓ PubMed
Meta-analysis of 4,238,685 infants (16 studies; 21,571 cocaine-exposed): prenatal cocaine exposure was associated with a 4.4-fold increased crude risk of sudden infant death syndrome (RR 4.40, 95% CI 2.52-7.67); any prenatal drug exposure raised SIDS risk 7.84-fold, persisting (RR 4.24) after adjustment for socioeconomic factors.
RCT
Contingency management critical period trial (Drug Alcohol Depend 2023)
✓ PubMed
In an RCT of 87 participants with cocaine use disorder, abstinence during the initial three-visit 'critical period' significantly predicted sustained abstinence across the 12-week contingency-management trial.
systematic_review
Levamisole-adulterated cocaine vasculitis, Microvasc Res 2025
✓ PubMed
Systematic review of 172 reports (302 patients, 93% levamisole-adulterated cocaine) documented skin involvement in 91% and kidney involvement in 21%, with thrombotic vasculopathy and/or leukocytoclastic vasculitis on biopsy; drug withdrawal is the mainstay of treatment.
Observational
Illicit stimulants & ventricular arrhythmias (Eur Heart J 2025)
✓ Full text
In a cohort of 29.6 million individuals (290,652 cocaine users), cocaine use was associated with incident ventricular arrhythmias (HR 1.15, 95% CI 1.10-1.19) and all-cause mortality (HR 1.68, 95% CI 1.64-1.72) after adjustment.
review
Acute Cardiovascular Toxicity of Cocaine, 2022
✓ PubMed
Review describing cocaine's acute cardiovascular toxicity (chest pain, ACS/MI, arrhythmia, hypertension) via sympathomimetic stimulation, coronary vasoconstriction and sodium-channel blockade, and outlining emergency management.
Safety / toxicology
Mortality
✓ PubMed
Any dose can cause sudden death via heart attack, stroke or seizure — even first use.
systematic_review
Castells et al., Cochrane Database Syst Rev 2016
✓ PubMed
Cochrane review of 26 RCTs (n=2366) found psychostimulant agonist medications modestly increased sustained cocaine abstinence (RR 1.36, 95% CI 1.05-1.77) but did not improve treatment retention or reduce overall cocaine use; evidence quality was very low.
systematic_review
Pani et al., Cochrane Database Syst Rev 2011
✓ PubMed
Cochrane review of 37 RCTs (n=3551) concluded antidepressants do not reduce cocaine use, treatment dropout, or dependence severity, providing no support for their use in cocaine dependence despite mood-related effects.
Review
Stroke data
✓ Source
Cocaine markedly raises risk of ischemic and hemorrhagic stroke, including in young users.
surveillance report
CDC MMWR 2025 (Stimulant overdose deaths)
✓ Source
Surveillance (Jan 2018-Jun 2024) showed cocaine-involved overdose death rate nearly doubled from 4.5 to 8.6 per 100,000; ~79% of cocaine-involved deaths co-involved opioids (mainly illicitly manufactured fentanyl).
meta_analysis
Impact of cocaine on cognitive inhibition, Neuropsychol Rev 2025
✓ PubMed
Systematic review and meta-analysis found cocaine users show significantly worse cognitive inhibition (impaired response/interference control) compared with non-using controls.
Observational
Stimulant-Involved CVD Mortality 2014-2023 (Subst Use Res Treat 2025)
✓ Full text
US cocaine-involved cardiovascular disease deaths rose at 6.5% average annual percent change over 2014-2023, totaling 15,352 deaths and 423,528 years of life lost.
Cohort
Mittleman et al. 1999 (Circulation)
✓ PubMed
Determinants of MI Onset Study, case-crossover analysis of 3,946 acute MI patients: the risk of MI onset was elevated 23.7-fold (95% CI 8.5-66.3) in the 60 minutes immediately following cocaine use, then declined rapidly thereafter, demonstrating cocaine as a potent acute trigger of myocardial infarction even in low-baseline-risk individuals.
meta_analysis
Gouin et al., Am J Obstet Gynecol 2011
✓ PubMed
Systematic review and meta-analysis of 31 studies found cocaine use in pregnancy roughly tripled the odds of low birthweight (OR 3.66), preterm birth (OR 3.38), and small-for-gestational-age infants (OR 3.23), with ~492 g lower birthweight.
Study
AHA / Circulation
✓ Source
Raises BP and heart rate while constricting coronary arteries — heart attack and stroke risk.