Like its predecessor, Carmageddon II was subject to criticism for the level of violence portrayed in the game. It is rated 15+ by ELSPA. In some countries, the pedestrians (and animals) are zombies, and blood is turned to green slime: In Germany, aliens replaced the pedestrians. Internet-released 'blood patches' restore the original human pedestrians. The blood pack was later released in the United Kingdom in 1999, earning the game an 18 certificate.
It features a heavy metal soundtrack with songs from Iron Maiden and instrumental tracks from Sentience.