Alcohol plus Cocaine: The Whole Is More Than the Sum of Its Parts

Jatlow, Peter; McCance, Elinore F.; Bradberry, Charles W.; Elsworth, John D.; Taylor, Jane R.; Roth, Robert H.

Editor(s): Oellerich, Michael

Editorial assistance for this issue was given by:Victor W. Armstrong,Göttingen; and members of the Editorial Board

Chairman, Department of Clinical Chemistry, Center for Internal Medicine, Georg-August University, Göttingen, Germany

Departments of Laboratory Medicine, Psychiatry, and Pharmacology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.

Address correspondence and reprint requests to Dr. P. Jatlow at Department of Laboratory Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, U.S.A.

Therapeutic Drug Monitoring18(4):p 460-464, August 1996.

Abstract

Summary

Cocaethylene, an active metabolite that arises through hepatic transesterification of cocaine when cocaine and ethanol are used together, shares many neurochemical and pharmacological properties with cocaine. Cocaethylene is similar to cocaine in its properties as an indirect dopamine agonist, and human subjects cannot distinguish its effects from those of cocaine. Cocaethylene, and especially its isopropyl analog, are more selective indirect dopamine agonists than cocaine, with relatively weak potency at the serotonin transporter. Cocaethylene may contribute to the manifestations and consequences of combined cocaine and ethanol use, although its relative importance remains unclear.