Cocaine update: abuse and therapy.

The most striking pharmacologic effect of cocaine is intense sympathetic stimulation, both centrally and peripherally. Physical dependence is much less severe than in opiate abuse. Psychologic dependence, however, is intense and is the primary problem in cocaine addiction. Although withdrawal symptoms are both somatic and visceral, severe depression is the dominant symptom. Therapy for withdrawal symptoms is not specific, but desipramine, bromocriptine and lithium have shown considerable promise. Acute overdose requires life support therapy. Appropriate pharmacologic interventions include intravenous diazepam to control central nervous system symptoms and propranolol or labetalol to control arrhythmias and hypertension.