UMEM Educational Pearls

Category: Toxicology

Title: Dexmedetomidine for Cocaine Induced Sympathomimetic Activity?

Keywords: dexmedetomidine, cocaine (PubMed Search)

Posted: 3/21/2013 by Fermin Barrueto, MD (Updated: 2/18/2020)
Click here to contact Fermin Barrueto, MD

Cocaine toxicity is characterized by the sympathomimetic toxidrome: tachycardia, hypertension, hyperpyrexia, diaphoresis as well as sodium channel blocking effects that can cause local anesthesia topically, QRS widening and even seizure.

Usual treatment for a cocaine toxic patient is benzodiazepines and cooling. Be wary of end organ damage, trauma and seizures.

There was a recent study that looked at dexmedetomidine to treat the sympathomimetic effects. Placebo-controlled trial used cocaine-addicted volunteer and applied intranasal cocaine. Measuring skin sympathetic nerve activity and skin vascular resistance, this study, unfortunately, showed as the dose increased  MAP did not fall further and increased paradoxically in 4 of 12 subjects.

This highlights the incredible physiologic mechanism of catecholamine release from the CNS with cocaine. This mechanism overlaps some with the centrally acting alpha agonist - dexmedetomidine and was shown in the study by Kontak et al. 

References

 

Dexmedetomidine as a novel countermeasure for cocaine-induced central sympathoexcitation in cocaine-addicted humans.

Kontak AC, Victor RG, Vongpatanasin W.

Hypertension. 2013 Feb;61(2):388-94