It’s not uncommon to experience facial bloating and puffiness after using cocaine. It even has its own name: “coke bloat.” It’s often most apparent in the cheeks and under the chin.

Here’s a closer look at why coke bloat happens, how to manage it, and how to avoid it.

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There could be a number of reasons for coke bloat, from fluid retention to hormonal issues. But one likely explanation for bloating after cocaine use is simply that the coke isn’t pure.

Levamisole, a veterinary deworming medicine, has become one of the most common adulterants in cocaine. It’s associated with a number of complications in humans, including skin necrosis, joint pain, and seizures.

Another side effect? Swollen glands. This includes the parotid glands, which are the large salivary glands in front of your ears. As levamisole is an irritant, it can cause them to swell up, giving the appearance of puffiness and bloating.

Plus, if you snort cocaine, it can irritate and inflame your nasal passages, which can also contribute to facial swelling.

Using cocaine may also cause non-facial bloating for a few reasons.

For one, cocaine causes the vasoconstriction — or narrowing — of blood vessels, resulting in a buildup of lymphatic fluid that can cause swelling and bloating.

This narrowing may also contribute to the development of peritonitis, or inflammation of the inner lining of your abdomen, according to a 2019 case study. One of the main symptoms of peritonitis is bloating.

Finally, not staying hydrated can also play a role. When your body isn’t getting enough water, it can slow down or halt digestion and hold onto excess water to help counter the effects of dehydration. As a result, you can experience some general bloating.

The internet is full of anecdotal coke bloat remedies that people swear by, but there’s no evidence to back them up.

Here are some of the most commonly recommended tips:

  • gently massaging your face for 5 to 10 minutes, followed by applying a cooling mask
  • applying a cold compress or taking a cold shower
  • using a derma roller on your face
  • applying hydrocortisone cream

There’s no guaranteed fix, and, while you can try the above strategies, they might not offer much relief. As the cocaine leaves your system, though, the bloating should start to subside.

While bloating on its own might not be particularly serious, it might appear alongside other symptoms indicating a more serious issue. Cocaine use can increase your risk of various cardiovascular issues, including myocarditis (inflammation of the heart wall).

Symptoms to watch out for include:

  • fatigue, joint pain, and fever
  • swelling of your legs, ankles, and feet
  • chest pain
  • shortness of breath

Cocaine use can contribute to respiratory issues, too, particularly when injected or smoked as crack. Among the most severe complications are pulmonary edema and pulmonary hemorrhage, or bleeding in the lungs.

It’s worth keeping an eye out for the following symptoms, as they could indicate a serious issue:

  • shortness of breath
  • coughing and wheezing
  • chest pain
  • coughing up blood

Talk with a healthcare professional if you experience any of these symptoms.

During the appointment, try to be as open about your substance use as possible. If you’re concerned about legal consequences, know that doctor-patient confidentiality laws prevent them from reporting this information to law enforcement.

Ultimately, the only surefire way to avoid coke bloat is to not use cocaine.

That said, making sure to stay hydrated and checking your drugs for contaminants may help minimize bloating. Keep in mind that testing is always a wise move if you use cocaine, as synthetic opioids, including fentanyl, are increasingly showing up in stimulants.

If you’re concerned about your cocaine use, consider the following routes to get help:

Adam England is a freelance writer and journalist. His work has appeared in publications including The Guardian, Euronews, and VICE UK. He focuses on health, culture, and lifestyle. When he’s not writing, he’s probably listening to music.