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Transtorno por uso de cocaína

最后审阅: 16 Aug 2025
最后更新: 22 May 2025

小结

Definition

History and exam

Key diagnostic factors

  • hipertensão
  • taquicardia
  • dor torácica
  • midríase
  • diaforese
  • tremor
  • agitação (leve a grave)
  • alterações do humor (por exemplo, irritabilidade, euforia, disforia, paranoia)
  • ideação suicida
Full details

Other diagnostic factors

  • ansiedade (estado de pânico: leve a grave)
  • formigamento induzido por medicamentos
  • hospitalização prévia para abstinência medicamente supervisionada
  • lesões relacionadas ao calor (por exemplo, vesículas, feridas e cortes na boa) ou queimaduras nos polegares
  • perfuração, ulceração do septo nasal
  • anormalidades neurológicas focais
  • convulsão
  • perda de consciência/alteração do nível de consciência
  • lesões cutâneas (por exemplo, marcas de perfuração, infecções, erosões, necrose)
  • dispneia
Full details

Risk factors

  • eventos adversos na infância
  • história de uso de múltiplas substâncias
  • história familiar de transtorno por uso de substâncias
  • história de transtorno de saúde mental
  • sexo masculino
Full details

Diagnostic investigations

1st investigations to order

  • exame toxicológico da urina ± cromatografia gasosa/ espectrometria de massa
  • eletrocardiograma (ECG)
  • enzimas cardíacas
Full details

Investigations to consider

  • radiografia torácica
  • tomografia computadorizada (TC) do crânio
  • eletroencefalograma
  • perfil sanguíneo abrangente
  • sorologia para hepatite
  • sorologia do HIV
Full details

Treatment algorithm

ACUTE

intoxicação aguda

adultas e adolescentes não gestantes: transtorno por uso de cocaína leve

adultas e adolescentes não gestantes: transtorno por uso de cocaína moderado a grave

gestante

ONGOING

remissão sustentada

resistente a tratamento

Contributors

Authors

Kim Wolff, MBE, PhD

Professor of Analytical, Forensic, and Addiction Science, Director, King’s Forensics

Faculty Life Science and Medicine

King’s College London

London

UK

Disclosures

KW declares that she has no competing interests.

Acknowledgements

Professor Kim Wolff would like to gratefully acknowledge Dr Steven B. Karch, the previous contributor to this topic.

Disclosures

SBK is an author of a number of references cited in this topic. SBK gives expert testimony and receives royalties from a textbook that he authored.

Peer reviewers

Andrew J. Saxon, MD

Professor

Department of Psychiatry and Behavioral Sciences

University of Washington School of Medicine

Seattle

WA

Disclosures

AS declares that he receives royalties from UpToDate, Inc.

Adam Bisaga, MD

Professor

Clinical Psychiatry

Columbia University College of Physicians and Surgeons

New York City

NY

Disclosures

AB declares that his research team and institution received funding and medication donations from Alkermes.

Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD

Consultant Psychiatrist and Honorary Senior Lecturer

Addictions, Alcohol Research

Institute of Psychiatry

King's College London

London

UK

Disclosures

CK declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

Clinical Guideline Committee (CGC) Members, ASAM Team, AAAP Team, et al. The ASAM/AAAP clinical practice guideline on the management of stimulant use disorder. J Addict Med. 2024 May-Jun 01;18(1s suppl 1):1-56.Full text  Abstract

Department of Health and Social Care. Drug misuse and dependence: UK guidelines on clinical management. Dec 2017 [internet publication].Full text

World Health Organization. Guidelines for identification and management of substance use and substance use disorders in pregnancy. Nov 2014 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

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    • Transtorno do humor
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  • Guidelines

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    • The ASAM/AAAP clinical practice guideline on the management of stimulant use disorder
    More Guidelines
  • Patient information

    Transtorno por uso de cocaína

    More Patient information
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