An ester local anaesthetic and a drug of abuse.

Rarely used as a topical anaesthetic.

As a topical preparation in the concentration range 4% to 10%.

The maximum dose is 1.5 mg/kg with a ceiling of 100 mg.

Allergy to ester local anaesthetics and parabens.

The potential for misuse of cocaine mean that it should only be used

on very rare occasions.

When abused cocaine can produce gingival bleeding due to thrombocytopenia.

Repeated local application to the gingivae can produce

oral ulceration, soft tissue and alveolar bone necrosis and localized

dental caries (the latter being due to carbohydrate contaminants).

Cocaine can produce psychological dependence, cardiotoxicity, and

liver damage.

Combined abuse with alcohol and barbiturates increases the likelihood

of liver damage. Cocaine produces sympathomimetic synergism

with epinephrine (adrenaline), thus epinephrine-containing

local anaesthetic solutions should be avoided or used with caution in

those who regularly abuse cocaine.