You have been logged out of VisualDx or your session has expired.

Please reload this page and sign into VisualDx to continue.

  VisualDx Mobile   Select Language

Get VisualDx Mobile

There are VisualDx mobile apps available for iOS and Android devices.

You will need a VisualDx account to use the mobile apps.

Already have an account? Sign In or
sign up for a free trial.

Users with VisualDx accounts earn CME credits for using VisualDx.

Already have an account? Sign In or
sign up for a free trial.

Create a Personal Account

E-mail (username)
Verify Password
First Name
Last Name

Personal Account Created

Mobile Access

You can now download VisualDx for your iOS and Android devices. Launch the VisualDx app from your device and sign in using your VisualDx personal account username and password.

CME Certification

Sign in with your personal account to earn and claim CME credits through VisualDx. Credits can be earned by building a differential or looking up a diagnosis.

Version: 7.11.1423   (build b7dc603)
Select Language

Select Region

Send us your feedback

This field is required

Oops! There was an issue during submission. Please try again. If the problem persists, email with your feedback.

Thank You!

We appreciate your feedback and you will be hearing from us soon.


Share This Page

Thank You!

We have sent an e-mail with a link to the current page.


E-mail This Patient Information Sheet

Thank You!

We have sent an e-mail with this patient information.


Image Contributors


  • Christine Ahn MD
    Carl Allen DDS, MSD
    Brandon Ayres MD
    Howard P. Baden MD
    Robert Baran MD
    Keira Barr MD
    Gregory J. Basura MD, Ph.D
    Donald Belsito MD
    Jeffrey D. Bernhard MD
    Jesse Berry MD
    Victor Blanco MD
    Benjamin R. Bohaty MD
    William Bonnez MD
    Sarah Brenner MD
    Robert A. Briggaman MD
    Robert Brodell MD
    Roman Bronfenbrener MD
    Walter Brooks MD
    William Buckley MD
    Philip Bulterys MD, PhD (candidate)
    Susan Burgin MD
    Sonya Burton MD
    Sean P. Bush MD, FACEP
    Jeffrey Callen MD
    Scott Camazine MD
    Michael Cardwell
    Shelley D. Cathcart MD
    Robert Chalmers MD, MRCP, FRCP
    Chia-Yu Chu MD, PhD
    Flavio Ciferri MD
    Maria Rosa Cordisco MD
    Noah Craft MD, PhD
    John T. Crissey MD
    Harold E. Cross MD, PhD
    Charles Crutchfield III MD
    Adriana Cruz MD
    Donna Culton MD, PhD
    Bart J. Currie MBBS, FRACP, DTM&H
    Chicky Dadlani MD
    Alexander Dane DO
    C. Ralph Daniel III MD
    Thomas Darling MD, PhD
    William Delaney MD
    Damian P. DiCostanzo MD
    Ncoza Dlova MD
    James Earls MD
    Libby Edwards MD
    Melissa K. Egge MD
    Charles N. Ellis MD
    Rachel Ellis MD
    David Elpern MD
    Nancy Esterly MD
    Stephen Estes MD
    E. Dale Everett MD
    Janet Fairley MD
    David Feingold MD
    Benjamin Fisher MD
    Henry Foong MBBS, FRCP
    David Foster MD, MPH
    Brian D. Foy PhD
    Michael Franzblau MD
    Vincent Fulginiti MD
    Sunir J. Garg MD, FACS
    Kevin J. Geary MD
    Lowell Goldsmith MD, MPH
    Sethuraman Gomathy MD
    Bernardo Gontijo MD, PhD
    Kenneth Greer MD
    Kenneth G. Gross MD
    Alan Gruber MD
    Nathan D. Gundacker MD
    Akshya Gupta MD
    Vidal Haddad MSC, PhD, MD
    Edward Halperin MD, MA
    Ronald Hansen MD
    John Harvey
    Rizwan Hassan MD
    Michael Hawke MD
    Jason E. Hawkes MD
    Peter W. Heald MD
    David G. Hicks MD
    Sarah Hocker DO
    Ryan J. Hoefen MD, PhD
    Li-Yang Hsu MD
    William Huang MD
    Sanjana Iyengar MD
    Alvin H. Jacobs MD
    Saagar Jadeja MD
    Shahbaz A. Janjua MD
    Joshua J. Jarvis MD
    Kit Johnson
    Robert Kalb MD
    A. Paul Kelly MD
    Henry Kempe MD
    Loren Ketai MD
    Sidney Klaus MD
    Ashwin Kosambia MD
    Jessica A. Kozel MD
    Carl Krucke
    Mario E. Lacouture MD
    Joseph Lam MD
    Alfred T. Lane MD
    Edith Lederman MD
    Nahyoung Grace Lee MD
    Pedro Legua MD, PhD
    Robert Levin MD
    Bethany Lewis MD
    Sue Lewis-Jones FRCP, FRCPCH
    Taisheng Li MD
    Christine Liang MD
    Shari Lipner MD, PhD
    Adam Lipworth MD
    Jason Maguire MD
    Mark Malek MD, MPH
    Jere Mammino DO
    Ricardo Mandojana MD
    Lynne Margesson MD
    Thomas J. Marrie MD
    Maydel Martinez MD
    Ralph Massey MD
    Patrick McCleskey MD
    Karen McKoy MD
    Thomas McMeekin MD
    Josette McMichael MD
    Somchai Meesiri MD
    Joseph F. Merola MD
    Mary Gail Mercurio MD
    Anis Miladi MD
    Larry E. Millikan MD
    Dan Milner Jr. MD
    Zaw Min MD
    Stephanie Montero
    Alastair Moore MD
    Keith Morley MD
    Dean Morrell MD
    Samuel Moschella MD
    Taimor Nawaz MD
    Vic Newcomer MD
    John Nguyen MD
    Matilda Nicholas MD
    Thomas P. Nigra MD
    Steven Oberlender MD, PhD
    Maria Teresa Ochoa MD
    Art Papier MD
    Lawrence Parish MD
    Tanner Parrent MD
    Mukesh Patel MD
    Lauren Patty-Daskivich MD
    David Peng MD, MPH
    Robert Penne MD
    Nitipong Permpalung MD
    Miriam Pomeranz MD
    Doug Powell MD
    Harold S. Rabinovitz MD
    Christopher J. Rapuano MD
    Sireesha Reddy MD
    Angela Restrepo MD, PhD
    Bertrand Richert MD, PhD
    J. Martin Rodriguez, MD, FACP
    Theodore Rosen MD
    Misha Rosenbach MD
    Scott Schiffman MD
    Robert H. Schosser MD
    Glynis A. Scott MD
    Carlos Seas MD, MSc
    Deniz Seçkin MD
    Daniel Sexton MD
    Paul K. Shitabata MD
    Tor Shwayder MD, FAAP, FAAD
    Elaine Siegfried MD
    Gene Sienkiewicz MD
    Christye Sisson
    Philip I. Song MD
    Mary J. Spencer MD, FAAP
    Lawrence B. Stack MD
    Sarah Stein MD
    William Van Stoecker MD
    Frances J. Storrs MD
    Erik J. Stratman MD
    Lindsay C. Strowd MD
    Erika Summers MD
    Belinda Tan MD, PhD
    Robert Tomsick MD
    Hensin Tsao MD, PhD
    Jenny Valverde MD
    Vishalakshi Viswanath MD
    Susan Voci MD
    Lisa Wallin ANP, FCCWS
    Douglas Walsh MD
    Ryan R. Walsh MD
    George Watt MD
    Clayton E. Wheeler MD
    Sally-Ann Whelan MS, NP, CWOCN
    Jan Willems MD, PhD
    James Henry Willig MD, MPH
    Karen Wiss MD
    Vivian Wong MD, PhD
    Sook-Bin Woo MS, DMD, MMSc
    Jamie Woodcock MD
    Stephen J. Xenias MD
    Lisa Zaba MD
    Vijay Zawar MD
    Bonnnie Zhang MD
    Carolyn Ziemer MD


  • Am. Journal of Trop. Med & Hygiene
  • Armed Forces Pest Management Board
  • Blackwell Publishing
  • Bugwood Network
  • Centers For Disease Control and Prevention
  • Centro Internacional de Entrenamiento e Investigaciones Mèdicas (CIDEIM)
  • Dermatology Online Journal
  • East Carolina University (ECU), Division of Dermatology
  • International Atomic Energy Agency
  • Massachusetts Medical Society
  • Oxford University Press
  • Radiological Society of North America
  • Washington Hospital Center
  • Wikipedia
  • World Health Organization
ContentsSynopsisCodesDrug Reaction DataReferencesView all Images (2)
Cocaine use disorder
Other Resources UpToDate PubMed

Cocaine use disorder

Print Images (2)
Other Resources UpToDate PubMed


Cocaine is a tropane alkaloid derived from the coca plant (Erythroxylum coca), which has pharmacological properties. It is a stimulant commonly seen as an illegal street drug available in different forms:
  • Cocaine base is usually smoked. Street names include freebase, crack, rock, twinkie, gravel, electric kool-aid, purple caps, black rock, scramble, window pane, supercoke, and yam.
  • Cocaine salt is usually absorbed through the mucous membranes (intranasal or oral) or injected. Street names include white lady, white dragon, nose candy, coke, blow, happy dust, aspirin, foo-foo dust, lady, Big C, coconut, Florida snow, devil's dandruff, and flake.
  • In a paste form, it is has been called pasta, basuco, and bazooka.
The effects of cocaine are described as a state of hyperalertness, energy, and euphoria.

Cocaine is identified as a Schedule II drug in the United States under the Controlled Substances Act.

DSM-5 Criteria:
Cocaine use disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) now combines the former concepts of substance dependence and substance abuse into a single diagnostic concept defined as mild, moderate, or severe.

The DSM-5 criteria address conditions and behaviors of an individual using cocaine that include urges or cravings, large amounts of time spent on cocaine activities, failure to stop or control use, interference with work, home, school, or previously enjoyed activities, awareness of risky behaviors, and impaired personal relationships related to cocaine use. The user of cocaine may experience a growing tolerance and onset of withdrawal symptoms.

Signs and Symptoms:
Cocaine toxicity, or acute intoxication, refers to the unintended effects of cocaine on the human organs, and which result in substance-related emergency room visits second only to acute alcohol toxicity. Accelerated progression of organ failure and convulsions can result in death within minutes.

A more protracted progression presents with behavioral changes (agitation, restlessness, anxiety, heightened emotions), circulatory changes (hypertension, pallor, pulse rate irregularities), respiratory changes, hyperthermia, and central nervous system signs (sweating, nausea, vomiting, tremor, headache, vertigo, teeth grinding).

Progressively worsening signs of encephalopathy, seizures, breathing impairment, and incontinence may be accompanied by cyanosis, flaccid paralysis, pulmonary edema, cardiac arrest, respiratory failure, and coma.

Other adverse effects include delusions, paranoia, hallucinations, impaired judgment, aggressive behavior, depressed mood, sleep disturbance, decreased appetite, weight loss, dyskinesia, dilated pupils, tachycardia, and cravings.

Cocaine use disorder may be diagnosed using a combination of medical history and substance use history, mental health assessment, clinical examination, self-assessment questionnaire, and lab tests. Several assessment instruments are available, including the Tobacco, Alcohol, Prescription Medication, and Other Substance Use Tool (TAPS).

Drug tests may not indicate recent cocaine use, so they cannot be used as a single diagnostic tool to determine chronic abuse. Complete assessment is recommended to address DSM-5 criteria for diagnosing cocaine use disorder and to determine the level of severity. Concurrent use of multiple substances, as cocaine in combination with alcohol, opiates, amphetamines, or other drugs, is not uncommon, so screening for other substances should be done simultaneously. A pregnancy test is also recommended.

Severe reactions to cocaine use include cardiovascular, pulmonary, and dermatological complications:
Cocaine use during pregnancy introduces adverse effects on the fetus and neonate, including the risk of preterm birth, underdevelopment of the fetus, placental abruption, and preeclampsia.

Emergency intervention first addresses the cardiovascular, respiratory, and central nervous system crises of cocaine toxicity. Steps are implemented to avoid life-threatening complications such as cardiac arrest, stroke, hyperthermia, respiratory failure, and rhabdomyolysis. Benzodiazepine may be used to manage seizures and aggressive behavior.

Once stabilized, the patient should be evaluated for recovery management. Patients undergoing withdrawal symptoms typically experience psychological effects, especially cravings, and can benefit from symptomatic relief and substance abuse counseling. Evidence-based treatment plans include psychotherapy, cognitive behavior therapy, motivational interviews, and lifestyle changes.


F14.99 – Cocaine use, unspecified with unspecified cocaine-induced disorder

78267003 – Cocaine abuse

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Updated: 03/23/2017
Copyright © 2018 VisualDx®. All rights reserved.
Cocaine use disorder
Print 2 Images
View all Images (2)
(with subscription)
Cocaine use disorder (Acute Cocaine Intoxication) : Tachycardia, Anorexia, Hypertension, Mydriasis, Hyperarousal, Euphoria
Copyright © 2018 VisualDx®. All rights reserved.