From the Guidelines
Administration of Beta Blockers in Patients with a History of Cocaine Use
Beta blockers should not be administered to patients with a history of cocaine use, even in the absence of chest pain, due to the risk of unopposed alpha-adrenergic stimulation and potential exacerbation of hypertension and coronary vasoconstriction 1.
- The use of beta blockers in these patients may worsen coronary spasm, as cocaine stimulates both alpha- and beta-adrenergic receptors, and beta blockers may leave alpha-mediated vasoconstriction unopposed 1.
- However, in cases where beta blockers are deemed necessary, a cautious approach with a low-dose, short-acting agent such as esmolol, at a dose of 0.25-0.5 mg/kg IV bolus, may be considered, with close monitoring of vital signs and cardiac function for at least 2-3 hours after administration.
- Key considerations include the patient's overall clinical presentation, the presence of any symptoms suggestive of coronary vasospasm, and the potential risks and benefits of beta blocker therapy in the context of recent cocaine use 1.
- It is essential to weigh the potential benefits of beta blockers against the potential risks, particularly in patients with a history of cocaine use, and to consider alternative treatment strategies, such as the use of benzodiazepines and nitroglycerin, to manage hypertension and tachycardia 1.
From the Research
Administration of Beta Blockers to Patients with a History of Cocaine Use
- The use of beta blockers in patients with a history of cocaine use is a topic of debate due to the potential risk of unopposed α-adrenergic stimulation and coronary vasospasm 2.
- A meta-analysis of studies comparing outcomes of β-blocker versus no β-blocker use among patients with cocaine-associated chest pain found no significant difference in non-fatal myocardial infarction and all-cause mortality between the two groups 2.
- However, the study suggests that beta blockers may be safe to use in patients with a history of cocaine use who do not exhibit symptoms of chest pain, such as angina pectoris.
Pharmacokinetics and Pharmacodynamics of Beta Blockers
- Beta blockers are a diverse group of drugs with varying pharmacokinetic and pharmacodynamic properties 3.
- The stereospecific pharmacokinetics and pharmacodynamics of beta blockers may affect their efficacy and safety in different patients 3.
- Understanding the pharmacokinetics and pharmacodynamics of beta blockers is essential to interpret and predict differences in pharmacologic responses among patients 3.
Clinical Use of Beta Blockers
- Beta blockers are commonly used to treat various cardiovascular disorders, including hypertension, angina pectoris, and congestive heart failure 4, 5, 6.
- The use of beta blockers in patients with congestive heart failure and concomitant obstructive airway disease is safe and may be beneficial 5.
- However, the benefit of beta blockers as first-line therapy for hypertension without compelling indications is controversial, and their effects on mortality and cardiovascular disease may be inferior to those of other antihypertensive drugs 6.