If anyone could add any input to this I would appreciate it...
30 or 40 years ago, propranolol was a mainstay in the treatment of cocaine toxicity. Then in the early 80's it was shown that patients given beta blockers while also suffering from cocaine toxicity had elevations in BP and that vasospasm may be worsened. Rather quickly, beta blockers fell out of favor for patients with MI or acute coronary syndrome associated with cocaine abuse and to this day, it is extremely unlikely any emergency or cardiac physician would treat such patients with beta blockers. However, the past decade or so has shown a reignition of the debate on the benefits of beta blockers for patients with acute cardiac issues due to cocaine use.
Much of the data supporting the theory of beta blockade results in unopposed alpha stimulation comes from small cases reports or animal studies not randomized studies making the veracity of the theory dubious. Further more, it has been shown that vasospasm may not be the cause of MI in cocaine toxicity, rather thrombosis formation due to cocaine's ability to cause platelet aggregation, increase vascular permeability and other factors. So if vasospasm is not the culprit and in all other ACS patients, beta blockers are recommended, it is a disservice to the cocaine abusing patients to withold them in treatment.
There are also conditions such as severe trauma, heart failure, and subarachnoid hemmorage that cause overstimulation of catecholamines in which beta blockers are widely used due to decreases in mortality and cardiac necrosis associated with beta stimulation. Utilizing beta blockers in these cases would lead to the same unopposed alpha stimulation theorized in cocaine toxic persons receiving beta blockers and as I said, there is no deleterious effects, rather beneficial results. So while you still probably would not get beta blockers if you go to the ER with chest pain after using cocaine, this is more from history rather than actual data showing the negative consequences.
Your situation is different as you are using bisoprolol for chronic management of hypertension, not an acute syndrome. I am unaware of any data saying combining cocaine with a beta blocker for high blood pressure, positive or negative. There are a few small reports of physicians utilizing carvedilol with great success in cocaine addicts with chronic heart failure, though. While not the same thing and carvedilol differs from most beta blockers as it also is an alpha blocker, it shows there may not be risks in administering beta blockers in those with long term CV disease who also use cocaine. And if the vasospasm due to alpha stimulation theory is actually correct, carvedilol may be ideal as its dual mechanism protects from both overstimulation of alpha and beta receptors.
