A cocaine overdose, also known as cocaine toxicity, can result in life-threatening consequences, including a stroke, heart attack, or seizure. It’s important to be able to identify cocaine overdose symptoms and signs so you can seek help for yourself or someone else. Call 911 immediately if you suspect an overdose.
Signs and Symptoms of a Cocaine Overdose
An overdose on stimulants like cocaine is very different than an overdose on depressants like opioids, alcohol, and benzodiazepines. An overdose on depressants is often dose-dependent and results in severe respiratory depression and slowed or stopped heartbeat. Conversely, a cocaine overdose can occur with any dose and is manifested by many cardiovascular events.
Cocaine overdose symptoms and signs may include: 
- Irregular heart rhythm
- Difficulty breathing
- High blood pressure
- High body temperature (hyperthermia)
- Extreme agitation or paranoia
- Anxiety or panic
- Heart attack
A cocaine overdose has the potential to be life-threatening and should be taken seriously. A person overdosing on cocaine is experiencing what is called cocaine toxicity, meaning they have taken a toxic dosage of cocaine. 
Notable Dangers of Cocaine Overdose
Cocaine’s adverse effects are caused by inhibiting the reuptake of catecholamines into a person’s nerve endings. Catecholamines are involved in how the body reacts to stress, helping to operate what is often called a person’s fight-or-flight response. 
Two notable dangers of a cocaine overdose are the drug’s effect on the way a person thinks and their cardiovascular system’s operations.
Someone who has taken a dangerous amount of cocaine may act irrationally and even dangerously. They can become paranoid, irritable, and extremely hyper. Especially when combined with the possibility of hallucinations, a person overdosing on cocaine may be incapable of making rational choices or correctly processing the events occurring around them.
Secondly, cocaine’s effect on the heart and other important systems means the person who is overdosing is at risk of heart attack, stroke, and seizure. In the worst cases, a person who experiences one of these symptoms may die, especially if they have pre-existing medical conditions that make these symptoms even more dangerous than they are for the general population. ,,
Overall, cocaine is a drug that can impact almost every organ in the body.
Risk Factors for Cocaine Overdose
Americans have seen a rise in cocaine-related deaths, with almost 20,000 people dying of a cocaine-related overdose in 2020, usually when the drug is used in combination with opioids.  Mixing cocaine with opioids like heroin and fentanyl is a major risk factor for overdose. And in general, buying street cocaine and using it can lead to an overdose since dealers often cut powdered cocaine with fentanyl, unbeknownst to the user.
Other risk factors include: , 
- Mixing cocaine with alcohol, which can form a deadly chemical in the body known as cocaethylene
- Injecting or snorting cocaine
- Co-occurring mental health disorders
- Unstable housing
- Witnessing an overdose
- Previous overdoses
- Cocaine use in public settings
A more obvious factor that puts a person at risk of a cocaine overdose is the amount of the drug taken. While no dose of cocaine should be considered “safe,” the more cocaine a person takes, the greater their risk of an overdose.
Smaller individuals will generally need to take less cocaine to experience an overdose compared to larger individuals.
How Much Cocaine Does it Take to Overdose?
Although “overdose” implies that a person has taken too much or a toxic amount of cocaine, the term is a bit misleading. This is because people can experience life-threatening effects like a stroke and even sudden death with relatively low doses of cocaine.
The median lethal dose of cocaine is about 43.54 mg per 1 pound of body weight. For a 140-pound person, that means the fatal cocaine dose would be around 6 grams. 
However, this is the median, or middle, which means there have been many cocaine overdoses at far lower and higher doses than this.
In general, a dangerous or fatal cocaine overdose amount will depend on many factors, such as:
- Individual physiology
- Person’s susceptibility to toxins
- Liver function
- Whether they are using other substances
- The potency of the cocaine, since its street form is unregulated
- Whether it’s cut with fentanyl or other opioids
Stages of Cocaine Toxicity or Overdose
Experts have recorded stages of cocaine overdose or toxicity, but keep in mind, everyone is different and while some people may move through these stages, others could experience life-threatening effects right away or experience sudden death. The stages of cocaine overdose may include:
|Stage||Cocaine overdose symptoms|
|Stage 1||Nausea, vertigo, twitching|
Increased blood pressure, rapid breathing
Paranoia, confusion, aggression, agitation
|Stage 2||Reduced oxygen flow to the brain, seizures|
Arrhythmias, rapid breathing, blue-ish skin, nails, fingers
|Stage 3||Coma, loss of vital functions|
Low blood pressure, cardiac arrest
Respiratory failure, gasping
What to Do in Case of an Overdose
If someone you know is exhibiting cocaine overdose symptoms, call 911 right away. Report your location and the symptoms of the person in trouble. The operator will want to know their medical history, which you should try to give as accurately as possible.
Follow the emergency operator’s instructions closely. It is important to be honest during this call, especially regarding whatever drugs the person took and how much. An accurate idea of what drugs are in the person’s system may be essential to saving their life.
There is no medication that can specifically reverse a cocaine overdose, although medical professionals can treat the symptoms of an overdose to help stabilize the person and keep them safe. Emergency medical care can greatly increase the chances that someone survives and reduce the potential that a cocaine overdose will cause permanent damage.
The primary goals of emergency overdose treatment are to: 
- Restore blood flow to the heart
- Get oxygen to the brain
- Stop a person from seizing
Treatment for a Cocaine Overdose
Once hospitalized, the treatment team may use many different interventions to stabilize a person who has overdosed on cocaine, depending on their symptoms. These interventions may include: 
- Managing fever with Tylenol and cooling measures
- Administering a pregnancy test
- Benzodiazepines to manage CNS hyperactivity
- Diltiazem and verapamil
- Nitroglycerin to lower blood pressure
- Antipsychotics for agitation or hallucinations
- Lidocaine for abnormal heart rhythm
Protection When You Call for Help
Many states have what are called “Good Samaritan” laws in place, which prevent legal action against individuals who call emergency services to help people experiencing an overdose, even if the activities engaged in that led to that overdose were illegal.
These laws exist to help encourage people who use drugs to seek help rather than ignore medical emergencies.
Addiction Treatment After a Cocaine Overdose
Although overdosing on cocaine doesn’t necessarily mean that you have an addiction, it can be a sign—especially when other symptoms of cocaine addiction are present, such as compulsive use regardless of negative consequences.
Once you are stabilized in the hospital, a professional, such as a case manager, social worker, or therapist, may counsel you on cocaine addiction treatment programs. They will even help you transition into a specific program so you can get the help you need.
With comprehensive addiction treatment, you can examine your cocaine use and determine what steps you need to take to get back in control of your life.
- Cocaine. (April 2021). National Institute on Drug Abuse.
- Cocaine Toxicity. (May 2022). StatPearls.
- Overdose Death Rates. (January 2022). National Institute on Drug Abuse.
- Acute and Chronic Effects of Cocaine on Cardiovascular Health. (February 2019). International Journal of Molecular Sciences.
- What Happens if You Mix Cocaine With Alcohol and/or Other Drugs? Drug Policy Alliance.
- Other Drugs. (November 2021). Centers for Disease Control and Prevention.
- Cardiovascular Effects of Cocaine. (December 2010). Circulation.
- Cocaine Use and Stroke. (June 2007). Postgraduate Medical Journal.
- Cocaine-Associated Seizures and Incidence of Status Epilepticus. (May 2010). The Western Journal of Emergency Medicine.
- Cocaine Toxicity. (May 2022). StatPearls.
- The Treatment of Cocaine Use Disorder. (October 2019). Science Advances.
- Brain Circuit Responsible for Cocaine Withdrawal-Induced Anxiety and Relapse-Related Behavior. (May 2022). University of California, Irvine.
- Risk Factors for Drug Overdose in Young People: A Systematic Review of the Literature. Lyons, R. M., Yule, A. M., Schiff, D., Bagley, S. M., & Wilens, T. E. (2019). Journal of child and adolescent psychopharmacology, 29(7), 487–497.
- Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework. Park, J.N., Rouhani, S. Beletsky, L., Vincent, L., Salonger, B., and Sherman, S.G. (n.d.). The Milbank Quarterly.
- Quest Database™ Cocaine Toxicity (LD50). AAT Bioquest, Inc. (2023, July 3).