A 30-year-old man regularly consumes large quantities of beer while snorting cocaine. His cardiologist explains that combining the two substances produces a unique compound that prolongs euphoria and carries greater cardiotoxicity than cocaine alone. The compound being described is:
- A Benzoylecgonine
- B Cocaethylene ✓
- C Norcocaine
- D Ecgonine methyl ester
Correct answer: B. Cocaethylene
Explanation
When ethanol is present, hepatic carboxylesterase transesterifies cocaine to cocaethylene, an active metabolite with a longer half-life than cocaine. It blocks dopamine reuptake similarly but produces greater cardiotoxicity and is implicated in sudden death among users who combine alcohol with cocaine. Benzoylecgonine and ecgonine methyl ester are inactive urinary metabolites used to detect cocaine use. Norcocaine is an oxidative metabolite associated with hepatotoxicity, not formed by alcohol co-ingestion.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.