β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon.
Publication/Presentation Date
5-1-2017
Abstract
Cocaine abuse remains a significant worldwide health problem. Patients with cardiovascular toxicity from cocaine abuse frequently present to the emergency department for treatment. These patients may be tachycardic, hypertensive, agitated, and have chest pain. Several pharmacological options exist for treatment of cocaine-induced cardiovascular toxicity. For the past 3 decades, the phenomenon of unopposed α-stimulation after β-blocker use in cocaine-positive patients has been cited as an absolute contraindication, despite limited and inconsistent clinical evidence. In this review, the authors of the original studies, case reports, and systematic review in which unopposed α-stimulation was believed to be a factor investigate the pathophysiology, pharmacology, and published evidence behind the unopposed α-stimulation phenomenon. We also investigate other potential explanations for unopposed α-stimulation, including the unique and deleterious pharmacologic properties of cocaine in the absence of β-blockers. The safety and efficacy of the mixed β-/α-blockers labetalol and carvedilol are also discussed in relation to unopposed α-stimulation.
Volume
22
Issue
3
First Page
239
Last Page
249
ISSN
1940-4034
Published In/Presented At
Richards, J. R., Hollander, J. E., Ramoska, E. A., Fareed, F. N., Sand, I. C., Izquierdo Gómez, M. M., & Lange, R. A. (2017). β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon. Journal of cardiovascular pharmacology and therapeutics, 22(3), 239–249. https://doi.org/10.1177/1074248416681644
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
28399647
Department(s)
Administration and Leadership
Document Type
Article