May 2024

By Dr. Justine Lee, DACVECC, DABT
Director of Medicine / CEO, VETgirl

How to Treat Cocaine Toxicity in Dogs

In this VETgirl online veterinary continuing education blog, we review cocaine toxicosis in dogs. While this is an uncommon type of toxin that dogs get into, it can be life-threatening without immediate recognition and treatment. If you’ve never seen a cocaine toxicity, these present BAD as they are very symptomatic! If you work with working dogs (e.g., police dogs), you’ll want to pay special attention to this potentially deadly toxin.

Cocaine is an illicit drug that works by preventing the reuptake of serotonin, dopamine and norepinephrine into the presynaptic neurons, so more is available at the synaptic cleft [1, 2]. You can read (or listen) to more information about cocaine poisoning in dogs HERE too. Below, a quick, short outline of what you need to know about this illicit drug!

Cocaine:

  • Nicknames: blow, snow, dust, toot, white lady, coke, bernies, rock, crank, flake, ice, beamers [1]
  • Natural plant alkaloid of Erythroxylon coca and E. monogynum
  • Typically a white power containing 12-16% cocaine salts and adulterants (Recently, contaminants include levamisole, fentanyl,  methamphetamines, caffeine, benzocaine, procaine, creatinine, miscellaneous other substances)[1,3]
  • Mechanism of action: sympathomimetic effects
  • Pharmacokinetics:
    • Rapidly absorbed within 12-15 minutes of exposure [1]
    • Readily crosses blood-brain-barrier (BBB)
    • Minor urinary excretion (10-20%) [1]
    • Dog: LD50 PO: 6-12 mg/kg [1]
  • Clinical signs:
    • Typically develop rapidly (within 12-15 minutes)
    • Central Nervous System (CNS): stimulation, bilateral mydriasis, hyperactivity/hyperexcitability, muscle tremors, seizures, ataxia
    • Gastrointestinal (GI): hypersalivation, vomiting
    • Cardiorespiratory: tachycardia, tachyarrhythmias, tachypnea, hypertension
    • Other: hyperthermia (secondary to tremors), coagulopathy (e.g., DIC), elevated creatine kinase (CK)
  • Treatment:
    • Decontamination:
      • Typically too late for decontamination due to rapid absorption. If dog is asymptomatic and large amount ingested, one can carefully consider emesis induction (due to rapid onset of clinical signs and seizures) and administration of one dose of activated charcoal
      • Note: If clinical signs are not present within 1 hour, unlikely to be toxic ingestion as clinical signs develop quickly, particularly with inhalation.
      • If “baggie” of cocaine ingested, must be removed by endoscopy (or surgery) once patient is stabilized (if possible).
    • Fluid therapy
      • IV crystalloid therapy
    • Gastrointestinal support
      • Antiemetic therapy to prevent aspiration (e.g., maropitant, ondansetron, etc.)
    • CNS support:
      • Muscle relaxants for tremors (e.g., methocarbamol, 22-110 mg/kg IV PRN)
      • Anticonvulsants for seizures
        • Diazepam 0.25-0.5 mg/kg IV PRN
        • Phenobarbital 4-20 mg/kg IV PRN
    • Cardiopulmonary support:
      • If tachycardia, check stat blood pressure (BP)
        • If hypotensive, consider fluid bolus
        • If hypertensive, consider sedative (e.g., acepromazine, butorphanol, etc.)
      • If persistent tachycardia (HR > 180 bpm in a dog), consider a beta-blocker (e.g., propranolol, 0.02 mg/kg)
      • If ventricular arrhythmias (e.g., VPCs) present, consider anti-arrhythmic therapy (e.g., lidocaine, 2-4 mg/kg, IV, followed by CRI 25-75 mcg/kg/min, IV)
    • Symptomatic supportive care
      • If severe metabolic acidosis (pH 7-7.1) and presence of arrhythmias, consider NaHCO3 therapy (1-2 mEq/kg IV slow)
      • Appropriate thermoregulation; consider cooling measures if severely hyperthermic T > 105°F/40°C (until 103.5F°/39.7°C)

While this illicit drug isn’t a common toxicant, it must be treated aggressively in order to ensure the best outcome. Untreated, death can occur rapidly. When in doubt, the ASPCA Animal Poison Control Center should be consulted for life-saving advice.

ASPCA Animal Poison Control Center logo

Image by Jiri Plistil from Pixabay

References:
1. Bischoff K, Kang HG. Cocaine. In: Osweiler G, Hovda L, Brutlag A, Lee JA, eds. Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology, 1st Ed. Iowa City: Wiley-Blackwell, 2011; pp. 212-217.
2. Thomas EK, Drobatz KJ, Mandell DC. Presumptive cocaine toxicosis in 19 dogs: 2004-2012. J Vet Emerg Crit Care 2014; 24(2):201-207.
3. Payer, D.E., Young, M.M., Maloney-Hall, B., Mill, C., Leclerc, P., Buxton, J., the Canadian Community Epidemiology Network on Drug Use, & the National Drug Checking Working Group. (2020). Adulterants, contaminants and co-occurring substances in drugs on the illegal market in Canada: An analysis of data from drug seizures, drug checking and urine toxicology. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.

  1. Hannah Sazama says:

    I am fortunate enough to say I have yet to encounter a pet with a cocaine ingestion/toxicity. It seems as if most of the clinical signs align with the one methamphetamine case I’ve worked with. Being a baby VA (2.5 years in the field) VA, sometimes these things confuse me because it’s hard to understand that a dog whom ingested an “upper” drug could be hypotensive.. I queried senior technicians and they suggested vasodilatation? I’d love to see if that is the case.

  2. Lianna Brockway says:

    Is Keppra recommended for seizures in these toxicities?

    Is Activated Charcoal?

    Or Intra Lipids?

    Why/ why not?

    Thanks!

  3. Nicole Vansickle says:

    I have been a tech for 30 yrs never seen but wit the increase of drugs laced with other drugs I think this is important to know how to treat

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