---
title: "Amphetamines and Cocaine"
url: https://mghmclean.org/residents/handbk/part2a/amph.htm
description: "Amphetamines and Cocaine - a chapter of the MGH/McLean Residency Training Program in Psychiatry manual."
published: 2026-08-10
updated: 2026-08-10
---

# Amphetamines and Cocaine

Published 2026-08-10

PART 3 / CH 25

Siobhan O’Neill

|  | Amphetamines | Cocaine |
|---|---|---|
| Urine Levels | >1000ng/ml detectable | Cut-off 300 ng/ml |
| Duration of (+) result | 1-3 days after use | Peaks 4h after use, positive up to 48-72 h after use. Chronic, high dose use, positive up to 7-22 days after use |
| Serum Levels |  | T1/2= 30-90 minutes. |
| Duration of (+) result | Active metabolites in serum prolong | Only hours after use |
| Lab comment | False (+) (urine): buproprion, chlorpromazine, propranolol, pseudoephedrine, selegiline, tranylcypramine |  |
| Acute intoxication | Increased SBP and DBP.Agitation, exhaustion.Psychosis, paranoia. | Pupillary dilatation, diaphoresis/chills, nausea/vomiting.Alertness, euphoria, and well-being. Decreased hunger and need for sleep. Paranoia/suspiciousness,overt psychosis, delirium. Anxiety, anger, tension, impaired cognition. |

| (cont.’d) | Amphetamines | Cocaine |
|---|---|---|
| Complications | Amphetamine psychosis: paranoia, ideas of reference. Hallucinations may develop. Increased startle response. Heightened awareness of environment, social isolation.Hypertensive episodes with cerebral hemorrhage Ventric. arrhythmias | **Cardiovascular**arrhythmia, chest pain, MI**Pulmonary**respiratory depression, pulmonary edema,pneumothorax**Neuro**confusion, seizure,transient focal deficitsvasospasm, stroke, hemorrhagedystonias/dyskinesias |
| Treatment of acute intoxication | Symptomatic.**Recognize potential for violence**. | Symptomatic.**Recognize potential for violence.**Consider medical consult. |
| Withdrawal | **“Crash” phase**: depression, agitation, anxiety, anergia, craving, insomnia, then hypersomnolence, hyperphagia.**Middle phase**: fatigue, anhedonia, intense drug craving.**Late phase**: brief periods of craving | Dysphoria, anhedonia, depression, fatigue.Vivid and unpleasant dreams, insomnia or hypersomnia.Increased appetite,psychomotor retardation/agitation. |
| Treatment of withdrawal | Symptomatic.Uncomfortable but not life threatening. | No specific treatment. Uncomfortable but not life threatening. |