The Drug-Induced Respiratory Disease Website and App

Cocaine

Cocaine is mostly snorted. Review of cadiovascular complications: PMID 11484693. See also under crack cocaine and levamisole, as most cocaine samples are now laced with that adulterant (PMID 25544694, 30634141). Levamisole per se can cause ANCA-related vasculitis or DAH. Other cutting agents include phenacetin, caffeine, hydroxyzine and benzocaine. See PMIDs 9358986, 1731605, 17620460, 21980179, 23196334, 24429586, 29459175, 29782427, 30634141

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d

Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.e

Acute eosinophilic pneumonia (AEP)

I.t

Pneumoconiosis (silicosis, talcosis...)

I.z

An area or areas of consolidation

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)

II.d

Pulmonary edema, cardiogenic

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

III.b

Pneumorenal syndrome (w/wo ANCAs)

III.c

Hemoptysis

III.n

Alveolar hemorrhage (subclinical, or as a BAL feature)

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma

IV.f

Severe or catastrophic bronchospasm or asthma attack (can be fatal)

IV.o

Airway hyperresponsiveness

V - Pleural and/or pericardial involvement

V.f

Pneumothorax

V.ab

Pneumothorax, bilateral

VI - Pulmonary vasculopathy

VI.a

Pulmonary embolism - Venous thrombosis/thromboembolism

VI.b

Pulmonary arterial hypertension

VI.l

Acute pulmonary vasoconstriction and PHT

VII - Mediastinal involvement

VII.h

Pneumomediastinum

VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement

VIII.a

Angioedema (may cause UAO, asphyxia and death)

VIII.c

Upper airway obstruction other than angioedema or hematoma

VIII.i

Midline destructive lesions

VIII.m

Drug foreign body in the airway

VIII.w

Uvulitis, uvular edema

VIII.ah

Tracheal polyps

VIII.ai

Nasal, palatal and/or pharyngeal pathology

VIII.ak

Rhinitis medicamentosa

VIII.ap

Airway foreign body

VIII.aw

Foreign body in the airway

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.k

Trismus (lockjaw)

IX.o

Pneumorachis

X - Systemic/Distant conditions, syndromes and reactions

X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

X.h

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

X.j

Myopathy-Myositis-Polymyositis (see also under Xba)

X.m

Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)

X.o

Neutrophilic dermatosis (Pyoderma, Sweet syndrome)

X.s

Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive

X.u

Multiple organ dysfunction/failure (MODS/MOF)

X.x

ANCA positivity. Subclinical or with clinical manifestations

X.ac

Anti-GBM antibody disease (Goodpasture-like or flare of preexisting GS)

X.ad

Skin purpura, ecchymoses or necrosis

X.as

Scleroderma renal crisis

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent

XI.m

Pulmonary emphysema - Lung cysts or bullae

XI.n

Neutropenia, agranulocytosis (w/wo infection/sepsis)

XI.r

Death following exposure or poisoning

XI.ae

Barotrauma (incl. pneumothorax, pneumomediastinum, interstitial ephysema...)

XI.az

Sneezing (may cause pulmonary barotrauma)

XII - Cardiovascular involvement / toxicity

XII.a

Left or biventricular dysfunction/failure

XII.e

Takotsubo (stress) cardiomyopathy

XII.f

Cardiomyopathy (acute, subacute, chronic)

XII.g

Coronary artery disease (acute) - Myocardial ischemia/infarction

XII.l

Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)

XII.y

Pneumopericardium

XII.ae

Aortic dissection

XII.af

Coronary vasospasm - Vasospastic angina

XII.aj

Systemic arterial thrombosis

XII.ap

Coronary artery dissection

XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)

XIV.c

Carboxyhemoglobinemia

XV - Pathology

XV.b

Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

XV.g

Path: Alveolar hemorrhage (see also IIIa)

XV.h

Path: NSIP-fibrotic pattern

XV.s

Path: Pneumoconiosis (silicosis, talcosis, talcoma)

XV.w

Path: Pulmonary edema (see also II/IIa)

XV.aw

Path: Skin vasculopathy/vasculitis/fibrin thrombi

XVI - Imaging

XVI.k

Imaging: An area or areas of consolidation

XVII - Infections & related conditions

XVII.b

Opportunistic pulmonary/systemic infections