cocaine hydrochloride, a white crystalline powder used as a local anesthetic. It was originally derived from coca leaves but can also be prepared synthetically. Cocaine is a Schedule I drug under the Controlled Substances Act of 1970. Cocaine hydrochloride solution should be freshly made; it deteriorates rapidly on standing and cannot be heat-sterilized. ▪ INDICATIONS: Can be used to treat prolonged epistaxis in a 4% topical solution. It is sometimes used topically for its anesthetic properties. Cocaine use should be limited. It is highly addictive. ▪ CONTRAINDICATIONS: It is incompatible with all alkaloid precipitants, mercurials, and silver nitrate. Central nervous system overstimulation may result from use with monoamine oxidase inhibitors, amphetamines, or guanethidine. Combination with epinephrine or norepinephrine can lead to cardiac arrhythmias or ventricular fibrillation. Persons with severe cardiovascular disease, thyrotoxicosis, hypotension, or hypertension should not take this drug. ▪ ADVERSE EFFECTS: Among the most serious adverse effects are excitement, depression, euphoria, restlessness, tremors, vertigo, nausea, vomiting, hypotension, hypertension, abdominal cramps, exophthalmia, mydriasis, peripheral vascular collapse, tachypnea, tachycardia, chills, fever, coma, and death from respiratory failure.
