Cocaine and Ketamine Therapy | Tovani Health

If you take Coke regularly and are considering at-home ketamine therapy, the combination is not currently a candidate. This page covers the brief pharmacologic context and what we do at intake.

How Coke interacts with ketamine

Cocaine blocks reuptake of serotonin, dopamine, and norepinephrine, and also blocks sodium channels (its original use was as a local anesthetic). The cardiovascular effects can be severe and additive with ketamine's transient pressor response. The combination-specific case literature is thin, but cocaine-alone cardiovascular toxicity is exceptionally well documented.

What we do at intake

Honest disclosure matters more than the diagnosis. We require at least 2 weeks of abstinence before starting KAP. Patients in active stimulant use disorder benefit more from treatment-program coordination than at-home KAP. We are not an enforcement service and will not report disclosed use; honest answers let us plan safely.

Bottom line

Cocaine is a DEA Schedule II controlled substance in the United States. It has a narrow legitimate medical use as a topical anesthetic in certain surgical settings, but recreational possession and use are federal felonies in every state. That legal status alone shapes what we can supervise. Clinically, the case against combining is stronger than for MDMA or LSD because the concern is cardiovascular, not just CNS-depression theory: cocaine causes documented hypertension, tachycardia, vasoconstriction, and is independently associated with MI, stroke, aortic dissection, and arrhythmia. Ketamine adds a transient sympathomimetic pressor response on top of that baseline. We will not run a ketamine session in proximity to cocaine use, and patients in active stimulant use disorder generally benefit more from coordinated addiction treatment than at-home KAP.