The association between cocaine use and acute gastroduodenal perforation is known. The effect of cocaine and stress on gastric mucosal ulceration and the levels of prostaglandin E2(PGE2) and leukotriene C4(LTC4) was studied in 40 Sprague–Dawley rats. Controls received intraperitoneal (i.p.) saline, ten received i.p. cocaine (35 mg/kg), ten were stressed by the cold restraint method, and ten had i.p. cocaine and stress. Cocaine alone did not induce ulceration, but decreased PGE2levels. Stress alone caused ulceration, but was not associated with a change in either PGE2or LTC4levels. When combined with stress, however, cocaine caused a three-fold increase in ulceration and a significant increase in PGE2and LTC4levels. Stress may predispose the cocaine addict to loss of gastroduodenal mucosal integrity, which is related to an imbalance of PGE2and LTC4synthesis.