Cocaine (KOE-kane) is a local anesthetic. It is applied to certain areas of the body (for example, the nose, mouth, or throat) to cause loss of feeling. This allows some kinds of examinations or surgery to be done without causing pain.

Cocaine can cause psychological dependence (a strong desire to continue using the medicine because of the ``high'' feeling it produces). This may lead to cocaine abuse (more frequent use and/or use of larger amounts of cocaine) and to an increased chance of serious side effects. Cocaine abuse has caused death from heart or breathing failure.

Use of cocaine as a local anesthetic for an examination or surgery is not likely to cause psychological dependence or other serious side effects. However, if cocaine is absorbed into the body too quickly, serious side effects can occur. Also, some people are especially sensitive to the effects of cocaine. Unwanted effects may occur in these people even with small amounts of the medicine. Before receiving cocaine as a local anesthetic, you should discuss its use with your doctor.

Cocaine is applied only by or under the immediate supervision of your doctor. It is available in the following dosage forms:

Mucosal-Local
• Crystals (U.S. and Canada)
• Solution (U.S.)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For cocaine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to cocaine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Studies on birth defects or other problems have not been done in pregnant women receiving cocaine as a local anesthetic. However, studies in women who abused cocaine during pregnancy have shown that cocaine may cause birth defects, decreased birth weight and size, and problems affecting the baby's nervous system. These studies have also shown that too much use of cocaine may cause the baby to be born too soon, sometimes too soon to survive. Cocaine has also been shown to cause birth defects and other unwanted effects in animal studies.

Breast-feeding—Cocaine passes into the breast milk and may cause unwanted effects such as convulsions (seizures), high blood pressure, fast heartbeat, breathing problems, trembling, and unusual irritability in nursing babies. Therefore, after receiving this medicine you should stop breast-feeding your baby for about 2 days.

Children—Cocaine can cause serious side effects in any patient. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

Older adults—Side effects, including dizziness or lightheadedness or fast or irregular heartbeat, may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of cocaine.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving cocaine, it is especially important that your health care professional know if you are taking any of the following:

• Amantadine (e.g., Symmetrel) or
• Amphetamines or
• Antimyasthenics (ambenonium [e.g., Mytelase], neostigmine [e.g., Prostigmin], pyridostigmine [e.g., Mestinon]) or
• Appetite suppressants (diet pills), except fenfluramine (e.g., Pondimin), or
• Beta-blockers (acebutolol [e.g., Sectral], atenolol [e.g., Tenormin], betaxolol [e.g., Kerlone], carteolol [e.g., Cartrol], labetalol [e.g., Normodyne], metoprolol [e.g., Lopressor], nadolol [e.g., Corgard], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol], pindolol [e.g., Visken], propranolol [e.g., Inderal], sotalol [e.g., Sotacor], timolol [e.g., Blocadren]) or
• Betaxolol (ophthalmic) (e.g., Betoptic) or
• Caffeine (e.g., NoDoz) or
• Chlophedianol (e.g., Ulone) or
• Cyclophosphamide (e.g., Cytoxan) or
• Demecarium (e.g., Humorsol) or
• Echothiophate (e.g., Phospholine Iodide) or
• Guanadrel (e.g., Hylorel) or
• Guanethidine (e.g., Ismelin) or
• Isoflurophate (e.g., Floropryl) or
• Levobunolol (e.g., Betagan) or
• Levodopa (e.g., Dopar) or
• Malathion (e.g., Prioderm) or
• Medicine for asthma or other breathing problems or
• Medicine for colds, sinus problems, or hay fever or other allergies (including nose drops or sprays) or
• Methyldopa (e.g., Aldomet) or
• Methylphenidate (e.g., Ritalin) or
• Metipranolol (e.g., OptiPranolol) or
• Nabilone (e.g., Cesamet) or
• Pemoline (e.g., Cylert) or
• Thiotepa or
• Timolol (ophthalmic) (e.g., Timoptic)—The chance of serious side effects may be increased

• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])—Receiving cocaine while you are taking or within 2 weeks after you have taken an MAO inhibitor may increase the chance of serious side effects.

Also tell your doctor if you have recently used an insecticide (insect killer) or if you have been in an area that was recently treated with an insecticide. Some insecticides can slow the breakdown of cocaine in your body. This increases the chance of serious side effects.

• Cancer or
• Chest pain, or history of, or
• Convulsions (seizures), history of, or
• Fast or irregular heartbeat or
• Heart or blood vessel disease or
• High blood pressure or
• Liver disease or
• Myocardial infarction (``heart attack''), history of, or
• Overactive thyroid—The chance of serious side effects may be increased

• Tourette's syndrome—Cocaine can make your condition worse

Dosing—

The dose of cocaine will be different for different patients. It will depend on the reason a local anesthetic is needed and on the size of the area to which it is being applied. Your doctor or nurse will apply the medicine.

• For mucosal-local dosage forms (crystals or solution):
  • For causing loss of feeling before examinations or surgery:
    • Adults and teenagers—Your doctor or nurse will apply the smallest amount of cocaine that will produce the needed effect. The largest amount that is usually used is 400 milligrams (mg).
    • Children up to 12 years of age—Use and dose must be determined by your doctor.

Cocaine and some of its metabolites (substances to which cocaine is broken down in the body) will appear in your blood and urine for several days after you have received the medicine. Tests for possible drug use will then be ``positive'' for cocaine. If you must have such a test within 5 days or so after receiving cocaine, be sure to tell the person in charge that you have recently received cocaine for medical reasons. It may be helpful to have written information from your doctor stating why the medicine was used, the date on which you received it, and the amount you received.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

After cocaine has been applied, your doctor or nurse will closely follow its effects. However, tell your doctor or nurse immediately if any of the following side effects occur:

• Signs and symptoms of too much medicine being absorbed into the body
  • Abdominal or stomach pain;  chills;  confusion;  dizziness or lightheadedness ;  excitement, nervousness, restlessness, or any mood or mental changes;  fast or irregular heartbeat;  general feeling of discomfort or illness;  hallucinations (seeing, hearing, or feeling things that are not there);  headache (sudden);  increased sweating ;  nausea 
  
  

Other side effects may occur that usually do not need medical attention. However, check with your doctor if the following side effects continue or are bothersome:

• More common
  • Loss of sense of taste or smell (after application to the nose or mouth) 
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, tell your doctor or nurse immediately.