Excretion of cocaine and its metabolites in man

Fish, F.; Wilson, William D

doi:10.1111/j.2042-7158.1969.tb08363.x

Cited by 103 publications

(17 citation statements)

References 5 publications

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“…1>2 Reliance on self-reporting underidentifies users, 6 and cocaine metabolites are detected in the urine for only 48 hours after use. 7 Therefore, the actual incidence of cocaine use in pregnancy may be considerably higher than reported. To our knowledge, this is the first study to investigate the rate and effect of recent cocaine use in a metropolitan population of predominantly Hispanic and African-American women presenting with preterm uterine contractions with intact membranes.…”

Section: Discussionmentioning

confidence: 94%

Cocaine is Associated with Intrauterine Fetal Death in Women with Suspected Preterm Labor

Martinez

Larrabee²,

Monga³

1996

Amer J Perinatol

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The objectives of this study were to determine the rate of recent cocaine use in a metropolitan population of predominantly Hispanic and African-American women with suspected preterm labor and to evaluate the impact of recent cocaine use on intrapartum complications in this population. Urine toxicology screens were prospectively obtained on 102 women with suspected preterm labor. The urine screen did not influence management decisions. Gestational age at delivery, birthweight, and intrapartum complications were compared using Student's t-test, chi-square analysis, or Fisher's exact test. The rate of positive urine drug screens for cocaine was 12.7%. Women with positive toxicology were older (27.8 +/- 5.7 versus 22.1 +/- 4.8 years, p = 0.002) and of higher parity (2 [1 to 7] versus 1 [0 to 7], p = 0.0). Women with positive toxicology were more likely to be black (92.3%) than Hispanic (7.7% [p = 0.0004]). They had more advanced cervical dilation at presentation (3 cm [0 to 6] versus 1 cm [0 to 8], p = 0.008), were more likely to be admitted (85% versus 32%, p < 0.0001), but less likely to receive tocolysis due to advanced dilation or pregnancy complication (36% versus 79%, p = 0.0002). There was no difference in gestational age or birthweight at delivery. There was a significantly higher intrauterine fetal death rate in the cocaine positive group (18.2% versus 0%, p = 0.02). These data suggest that recent cocaine use among women with suspected preterm labor is common in only some segments of an urban population and significantly impacts pregnancy outcome.

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Section: Discussionmentioning

confidence: 94%

Cocaine is Associated with Intrauterine Fetal Death in Women with Suspected Preterm Labor

Martinez

Larrabee²,

Monga³

1996

Amer J Perinatol

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“…Cocaine induced a rapid transient increase in the passage of HRP through endothelial monolayers with maximal differences noted at 30 min and 1 hr compared with control filters. This desensitization of the cocaine response may be the result of its breakdown to an inactive metabolite (14). It is possible that cocaine increased permeability by producing lethal endothelial cell injury ; however, endothelial cell viability as assessed by 5' Cr-release assay was not significantly different from controls.…”

Section: Discussionmentioning

confidence: 95%

Increased Prevalence of Aortic Fatty Streaks in Cholesterol-Fed Rabbits Administered Intravenous Cocaine: The Role of Vascular Endothelium*¹

Cornhill

et al. 1993

Toxicol Pathol

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Several recent postmortem studies suggest an increased prevalence of atherosclerosis in young habitual cocaine abusers. However, little is known about the effects of cocaine abuse on the vascular endothelium and its relationship to atherosclerosis. Therefore, the consequence of chronic administration of intravenous cocaine on the induction of aortic sudanophilia was examined. Male New Zealand White rabbits were fed a 0.5% cholesterol diet for 10 wk. During this period, animals were randomized to receive either cocaine-hydrochloride (0.25 mg/kg) intravenously (n = 17) twice daily; or an equivalent volume of 0.9% physiologic saline, control group (n = 16). Mean values for total circulating leukocytes and platelets and total plasma cholesterol and triglycerides were similar in both groups throughout the protocol. At the completion of the study, aortic sudanophilia was measured and expressed as a percentage of regional involvement (R1 = proximal 4 cm, R2 = middle 6 cm, and R3 = distal 10 cm). Statistical significance among groups was achieved in the proximal thoracic aorta (p = 0.057). No significant differences in sudanophilia were noted in the middle and distal segments. When animals were placed in subgroups according to percent total plaque involvement, there was a significant increased distribution of rabbits with a greater extent of sudanophilia in the cocaine-treated group as compared with control (p = 0.01, chi-square analysis). Immunocytochemical studies using the macrophage-specific and muscle actin-specific monoclonal antibodies demonstrated that sudanophilic areas in both groups were predominantly composed of macrophage-derived foam cells. Evaluation of plaque morphology showed an increase in intimal plaque thickness and in the number of macrophages and smooth muscle cells in cocaine-treated animals; however, group differences were not statistically significant. Because no significant differences were found in the cellular composition of atherosclerotic plaques between groups, further studies were performed to assess the effects of cocaine on the permeability function of cultured endothelial cell monolayers as a possible mechanism of increased sudanophilia. Cocaine (100 microM)-treated endothelial cell monolayers demonstrated an increased permeability to horseradish peroxidase during all time intervals studied (0-6 hr). Permeability differences were statistically significant at 30 min and 1 hr (p = 0.003 and 0.02, respectively). Collectively, these observations suggest that administration of cocaine to cholesterol-fed rabbits increases the prevalence of aortic sudanophilia via at least one possible mechanism involving enhanced vascular permeability.

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“…It has been difficult to accurately determine the rate of cocaine use among pregnant women because only 40% of patients with positive urine toxicology screens admit to recent use 6 and cocaine metabolites are detected in the urine for only 48 hr after use. 7 This study utilized urine toxicology to estimate recent cocaine use in a metropolitan population of predominantly Hispanic and African-American women presenting with preterm PROM. In our patient population, the rate of positive urine cocaine screens in women with preterm PROM was 8.2%, which is lower than has previously been reported.…”

Section: Discussionmentioning

confidence: 99%

Preterm Premature Rupture of the Membranes Associated with Recent Cocaine Use

Delaney

Larrabee²,

Monga³

1997

Amer J Perinatol

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The objective of this study was to determine the rate of recent cocaine use among a metropolitan population of predominantly Hispanic and African-American women with preterm premature rupture of the membranes (PROM) and to ascertain the impact of cocaine on the latency period between rupture of membranes and delivery. Urine toxicology screens were prospectively obtained on 147 women with preterm PROM. The urine screen did not influence management decisions. All women were expectantly managed without tocolytics until 37 weeks' gestation unless they developed clinical chorioamnionitis, or nonreassuring fetal heart rate tracing or biophysical profile. Demographic information, hours from rupture of membranes to delivery, gestational age, and birth weight at delivery were compared using Fisher's exact, Mann-Whitney U, and randomization tests where appropriate. The rate of positive urine drug screens for cocaine was 8.2%. Women in the cocaine positive group were of higher parity (3, [0-7]vs. 1, [0-6], p = 0.001) and tended to be older (27, [23-42]vs. 25, [14-40]). There was a higher rate of recent cocaine use among African-American women (20.4%) as compared to non-African-Americans (1.2%, p = 0.0001). Cocaine-positive women presented at an earlier gestational age (32 weeks', [24-34]vs. 33 weeks', [23-36], p = 0.02) and had a significantly longer membrane rupture to delivery interval than women with a negative urine drug screen (174 hr, [6-475]vs. 33 hours [1-833], p = 0.01). There was no significant difference in the reason for delivery between the two groups of patients. Recent cocaine use among women with preterm PROM is common in only some segments of an urban population. Women with recent cocaine use present with ruptured membranes at an earlier gestational age and may actually have a longer latency period than women who do not use cocaine.

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Excretion of cocaine and its metabolites in man

Abstract: Little information exists on the metabolism, distribution and excretion of cocaine in persons dependent upon it. We now present results showing the proportions of cocaine excreted unchanged and as its metabolite benzoylecgonine.

Cited by 103 publications

References 5 publications

Cocaine is Associated with Intrauterine Fetal Death in Women with Suspected Preterm Labor

Cocaine is Associated with Intrauterine Fetal Death in Women with Suspected Preterm Labor

Increased Prevalence of Aortic Fatty Streaks in Cholesterol-Fed Rabbits Administered Intravenous Cocaine: The Role of Vascular Endothelium*¹

Preterm Premature Rupture of the Membranes Associated with Recent Cocaine Use

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Excretion of cocaine and its metabolites in man

Abstract: Little information exists on the metabolism, distribution and excretion of cocaine in persons dependent upon it. We now present results showing the proportions of cocaine excreted unchanged and as its metabolite benzoylecgonine.

Cited by 103 publications

References 5 publications

Cocaine is Associated with Intrauterine Fetal Death in Women with Suspected Preterm Labor

Cocaine is Associated with Intrauterine Fetal Death in Women with Suspected Preterm Labor

Increased Prevalence of Aortic Fatty Streaks in Cholesterol-Fed Rabbits Administered Intravenous Cocaine: The Role of Vascular Endothelium*1

Preterm Premature Rupture of the Membranes Associated with Recent Cocaine Use

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Increased Prevalence of Aortic Fatty Streaks in Cholesterol-Fed Rabbits Administered Intravenous Cocaine: The Role of Vascular Endothelium*¹