Table 1.

Clinical Effects of Common Adulterants Found in Heroin and Cocaine

Drug of abuse	Adulterant	Possible clinical effects
Heroin	Acetaminophen	Hepatic failure, irritability, seizure, coma
	Caffeine	Respiratory distress, arrhythmia, mental status change
	Chloroquine	Blindness, arrhythmias, tinnitus, seizures
	Clenbuterol	Tachycardia, hypotension, hypokalemia, hyperglycemia
	Cocaine	Tachycardia, arrhythmia, myocardial ischemia
	Diltiazem	Hypotension, bradycardia
	Diphenhydramine	Tachycardia, agitation, blurred vision, delirium, seizures
	Fentanyl	Respiratory depression, tachycardia, seizure
	Lidocaine	Arrhythmias, dizziness, confusion
	Methorphan	Seizures, tachycardia, hallucinations, coma
	Phenacetin	Renal failure, hemolytic anemia, methemoglobinemia
	Quetiapine	Respiratory failure, tachycardia, syncope
	Scopolamine	Anticholinergic toxicity
Cocaine	Atropine	Anitcholinergic toxicity
	Benzocaine	Methemoglobinemia
	Caffeine	Respiratory distress, arrhythmia, mental status change
	Diltiazem	Hypotension, bradycardia
	Hydroxyzine	Tachycardia, palpitations, hypotension, shortness of breath
	Levamisole	Agranulocytosis, lichenoid rash
	Lidocaine	Arrhythmia, seizure
	Methylephedrine	Arrhythmia, hypertension, respiratory distress
	Phenacetin	Renal failure, hemolytic anemia, methemoglobinemia