Cocaethylene formation following ethanol and cocaine administration by different routes.

Ethanol alters the hepatic biotransformation of cocaine, resulting in transesterification to a novel active metabolite, cocaethylene. Because of first pass metabolism, oral drug administration might be expected to produce relatively larger concentrations of cocaethylene than would intravenous or smoked administration. We, therefore, compared the effects of route of cocaine administration on the formation and elimination of cocaethylene. Six experienced cocaine users were tested in 6 sessions, approximately 1 week apart. Deuterium-labeled cocaine (d5) was administered in all conditions. Oral cocaine-d5 2.0 mg/kg, intravenous cocaine-d5 1.0 mg/kg, and smoked cocaine-d5 (200 mg) were administered after oral ethanol 1.0 g/kg or placebo. A small, intravenous dose of deuterated cocaethylene (d3) also was administered with all conditions for determination of cocaethylene formation. Physiologic and subjective effects were recorded and plasma cocaine-d5, cocaethylene-d5, cocaethylene-d3, and benzoylecgonine-d5 were measured by gas chromatography-mass spectrometry. About 24% (± 11) of intravenous cocaine was converted to cocaethylene. The oral route (34% ± 20) was significantly greater than from the smoked route (18% ± 11) and showed a trend toward significance for greater formation of cocaethylene compared to the intravenous route. Within each route, the cocaine-ethanol combination produced greater increases in heart rate and rate-pressure product than cocaine alone. Global intoxication effects across time after smoking or intravenous administration were significantly greater when cocaine and ethanol were both given. Administration of cocaine by different routes alters the amount of cocaethylene formed through hepatic first-pass effects. Increased cardiovascular and subjective effects might explain the toxicity and popularity of the combined drugs.

Combined effects of ethanol and cocaine on FOS-like protein and cocaethylene biosynthesis in the rat.

To study the simultaneous effects of ethanol and cocaine on striatal FOS-like protein, rats were exposed to an (8.7%) ethanol solution for 15 days followed by single or daily cocaine injections (20 mg/kg; IP). Ethanol consumption reduced the induction of the nuclear protein under both temporal regimens of cocaine administration. In contrast, sucrose pair-fed or ad libitum control groups exhibited a robust induction of FOS-like protein throughout the striatum, particularly in dorsal-central quadrants of the caudate putamen. This pattern of combined drug use produced blood ethanol concentrations in the range of 22-370 mg/dl, corresponding with those associated with mild intoxication in humans. Under both cocaine regimens, the presence of ethanol led to the transesterification of cocaine into the active metabolite, cocaethylene (31-121 ng/ml). Plasma levels of this metabolite did not exceed those of cocaine (17-1024 ng/ml), suggesting that under this drug regimen at least, cocaethylene formation is relatively low and perhaps dependent upon specific levels of ethanol and cocaine in hepatic microsomes. In addition, systemic administration of cocaethylene to rats (60 mumol/kg; molar equivalent of 20 mg/kg cocaine) induced widespread FOS-like protein in the caudate putamen. Induction of the transcription factor protein by cocaethylene was similar in magnitude and anatomic distribution to that of cocaine, suggesting that these two drug congeners share common molecular mechanisms of gene expression.