From the Guidelines
Beta blockers should not be used to treat methamphetamine intoxication or overdose, as they can potentially worsen the cardiovascular effects of methamphetamine. For methamphetamine toxicity, the primary treatments are supportive care, benzodiazepines for agitation/seizures, and cooling measures for hyperthermia [ 1 ]. Specific medications like haloperidol may be used for severe agitation or psychosis if benzodiazepines are insufficient.
Key Considerations
- Beta blockers can cause "unopposed alpha stimulation" when combined with stimulants like methamphetamine, leading to a dangerous spike in blood pressure and potential cardiovascular complications [ 2 ].
- The beta blockade prevents the body from counteracting some of methamphetamine's effects on the heart and blood vessels.
- If a patient on chronic beta blocker therapy uses methamphetamine, close monitoring is required [ 1 ]. However, abruptly stopping beta blockers can also be risky, and consultation with a physician is necessary for proper management in these cases.
Treatment Approach
- For methamphetamine addiction treatment, behavioral therapies are the primary approach [ 2 ].
- There are currently no FDA-approved medications specifically for treating methamphetamine use disorder.
- In patients with autonomic hyper-reactivity due to suspected methamphetamine intoxication, treatment with benzodiazepines should be initiated first, followed by consideration of phentolamine, nicardipine, or nitroprusside if additional BP-lowering treatment is needed [ 1 ].
From the Research
Effect of Beta Blockers on Methamphetamine
- There are no direct studies on the effect of beta blockers on methamphetamine in the provided evidence.
- However, studies on similar substances like MDMA (Ecstasy) and cocaine can provide some insights.
- A study on MDMA found that beta blockers can prevent increases in heart rate but not hypertensive and adverse effects 3.
- Another study on cocaine-associated chest pain found that early use of beta blockers appeared safe and did not support the presence of an "unopposed alpha adrenergic effect" 4.
- Beta blockers are known to interact with various drugs, including those that may be used in conjunction with methamphetamine, and can cause adverse reactions and interactions 5, 6.
- The use of beta blockers in patients with stimulant intoxication is often withheld due to concerns about increasing hypertension and coronary artery vasospasm, but some studies suggest that they may be safe in certain situations 3, 4.