Vasospasm-mediated cardiac arrhythmias and MI's, hypertension, strokes, and seizures result from direct effect of cocaine on vessels and nerve tissues. Other cocaine-related complications involve those implicated in the route of cocaine delivery. Psychiatric complications of cocaine use include disturbances of mood, reality testing, and psychosocial functioning. Patients should be observed for arrhythmias, focal CNS signs, suicidality, and psychotic symptoms. Because of rapid metabolism symptoms of acute intoxication usually disappear within hours.
Patients typically suffer from intense drug cravings, irritability, fatigue, and depression.
Some patients may exhibit suicidal and drug seeking behavior. As with other withdrawal states, cocaine withdrawal may contribute to agitation primarily secondary to other medical conditions. Adjunctive benzodiazepines may be ordered for sleep and anxiety. This syndrome is not a consequence of cocaine withdrawal per se. The delirium usually clears rapidly but patients are commonly violent.