Cocaine effects on digital blood flow and diffusing capacity for carbon monoxide among chronic cocaine users

Sullivan, John T.; Becker, Patrice M.; Preston, Kenzie L.; Wise, Robert A.; Wigely, Frederick M.; Testa, Margaret P.; Jasinski, Donald R.

doi:10.1016/S0002-9343(96)00453-6

« Previous Next »The American Journal of Medicine
Volume 102, Issue 3 , Pages 232-238, March 1997

Cocaine effects on digital blood flow and diffusing capacity for carbon monoxide among chronic cocaine users**

John T. Sullivan
- Requests for reprints should be addressed to Dr. J.T. Sullivan, Bayer Corporation, 400 Morgan Lane, West Haven, Connecticut 06516.
- From the Departments of Medicine, Psychiatry, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Maryland USA
Patrice M. Becker
- From the Departments of Medicine, Psychiatry, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Maryland USA
Kenzie L. Preston
- From the Behavioral Sciences, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Maryland USA
Robert A. Wise
- From the Departments of Medicine, Psychiatry, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Maryland USA
Frederick M. Wigely
- From the Departments of Medicine, Psychiatry, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Maryland USA
Margaret P. Testa
- From the Departments of Medicine, Psychiatry, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Maryland USA
Donald R. Jasinski
- From the Departments of Medicine, Psychiatry, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Maryland USA

Received 10 October 1995; received in revised form 18 November 1996

Purpose

To determine the acute effects of intravenous (IV) cocaine on primarily digital skin blood flow and diffusion capacity for carbon monoxide (CO), and secondarily on subjective and cardiovascular measures.

Patients and Methods

A double-blind, Latinsquare, placebo-controlled, dose-response study was conducted in an inpatient general clinical research center and clinical pharmacology unit of a university teaching hospital. Twelve adult males with histories of illicit drug use including IV cocaine received 0, 25, and 50 mg of IV cocaine given as 1-minute infusions, on 3 consecutive test days. Digital cutaneous blood flow was determined via laser doppler flowmetry and skin temperature. Diffusing capacity for carbon monoxide (D_CO) was measured with standard techniques. Subjective responses were measured by oral report of a numerical ranking of strength of drug effect. Heart rate and blood pressure responses were measured by electronic syphygmomanometer.

Results

A maximal decrease in skin blood flow occurred at 2 to 3 minutes after infusion, and was not distinguished among drug conditions. Blood flow returned to baseline more rapidly after placebo than after cocaine: 7 minutes (placebo), 35 minutes (25 mg cocaine), 50 minutes (50 mg cocaine). Skin temperature decreased by 1.25 °C after placebo and by 2.75 and 3.25 °C after 25 and 50 mg of cocaine, respectively. D_CO changed by −1.02 (mean) ± 0.25 (standard deviation), 0.16 ± 1.22, and 0.21 ± 1.63 ml/min/mm Hg following placebo, 25, and 50 mg of cocaine, respectively. Typical subjective, chronotropic, and pressor responses to cocaine were demonstrated, and these occurred in close temporal relationship to digital blood flow and skin temperature responses.

Conclusions

The digital cutaneous circulation is highly sensitive to vasoconstrictor effects of cocaine. Pulmonary blood volume tends to be preserved after IV cocaine. Subjective effects and cardiovascular responses occur in concert with peripheral blood flow changes. The peripheral vasoconstrictor effects have implications for cocaine users with concurrent vasospastic or vasculopathic disorders.

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