What Is ‘Coke Bloat’? And Can You Get Rid of It?

Experiencing a puffy, swollen face after using cocaine is fairly common — a phenomenon often called “coke bloat.” It usually shows up most noticeably in the cheeks and beneath the jawline.

Below is a closer examination of what drives coke bloat, ways to manage it, and tips to reduce the risk.

Healthline does not condone illegal drug use. We aim to share clear, evidence-based information to reduce potential harm linked to substance use.

Why does cocaine sometimes make the face look bloated?

Several factors can cause coke bloat, including fluid retention and hormonal imbalances. One prominent reason, however, is that the cocaine being used may be contaminated.

Levamisole, an anti-parasitic drug for animals, has become one of the most frequent cutting agents found in cocaine. In humans it’s been tied to a range of complications, including tissue death of the skin, joint pain, and seizures.

Another consequence is swollen glands — particularly the parotid glands, which sit in front of the ears and produce saliva. Because levamisole is irritating, it can trigger gland enlargement, producing a puffy or bloated facial appearance.

Additionally, snorting cocaine irritates and inflames the nasal lining, which can further contribute to facial swelling.

What about general, non-facial bloating?

Cocaine use can also lead to abdominal or generalized bloating for several reasons.

First, cocaine causes vasoconstriction — the narrowing of blood vessels — which can impede lymphatic drainage and lead to fluid buildup and swelling.

This vasoconstriction may also play a role in causing peritonitis, or inflammation of the abdominal lining, as described in a 2019 case report. Bloating is a common symptom of peritonitis.

Finally, inadequate hydration can worsen bloating. When you don’t drink enough fluids, digestion can slow and the body may retain water to compensate for dehydration, resulting in a generally bloated feeling.

Are there reliable ways to reduce it?

The web is full of anecdotal “cure” suggestions for coke bloat, but scientific support for these remedies is scarce.

Commonly suggested methods include:

• massaging the face gently for 5–10 minutes, then using a cooling mask
• applying a cold pack or taking a cool shower
• using a derma roller on the skin
• applying hydrocortisone cream

None of these approaches are guaranteed to work, though you can try them. In most cases, as the drug is metabolized and leaves the body, the swelling will gradually decrease.

When should you seek medical attention?

Isolated bloating might not be dangerous, but when it occurs with other symptoms it could signal a more serious condition. Cocaine raises the risk of several cardiovascular problems, including myocarditis (inflammation of the heart muscle), according to research that links cocaine use to heart issues.

Watch for these warning signs:

• extreme tiredness, joint aches, and fever
• swelling in the legs, ankles, or feet
• chest discomfort
• shortness of breath

Cocaine can also harm the lungs, particularly when smoked or injected as crack. Serious pulmonary complications include pulmonary edema and pulmonary hemorrhage (bleeding in the lungs).

Seek urgent care if you notice:

• difficulty breathing
• wheezing or persistent cough
• chest pain
• coughing up blood

If you experience any of these symptoms, consult a healthcare provider. During the visit, it’s helpful to be honest about substance use. Confidentiality protections generally prevent clinicians from disclosing this information to law enforcement.

Practical takeaway

The only certain way to prevent coke bloat is to avoid using cocaine altogether.

That said, staying well hydrated and testing substances for adulterants can help reduce the chance of severe bloating. Drug checking is particularly important because dangerous synthetic opioids like fentanyl are increasingly being mixed into stimulants.

If you’re worried about your cocaine use, consider these options for support:

• Speak with your primary care clinician if you feel comfortable doing so.
• Complete Shatterproof’s self-assessment to get guidance on next steps.
• Call the SAMHSA National Helpline at 800-662-4357 — it’s available 24/7.
• Locate a local support group through Narcotics Anonymous or the Support Group Project.

For additional related topics, you might find information on coke zero vs diet coke and how certain substances affect bloating useful; also see guidance on alcohol bloating for comparisons about fluid retention and puffiness.