Cocaine and Beta Blockers

[MDPVagrant]

http://www.themagellangrp.com/coursepdf/CocaineOverdose.pdf

Do a search on "beta-blockers" ...

Little known factoid (that IMO should be well known, so check it out). To put it directly, beta blockers should NEVER be used in conjunction with cocaine. Dangerous!

P.S. for those nutty enough to keep vasodilators &/or other heart meds around, use verapamil for cocaine-induced hypertension and irregular heartbeats. Watch out for symptomatic hypotension... low doses are indicated due to llloonngg length of onset and *short* length of cocaine symptoms. Nitroglycerin and such are better choices for brief episodes.

 

[mad_scientist]

I asked my doctor about this and he didn't think that the combination would be too dangerous at least at low doses, although he did agree that alpha-blockers would be better for treating cocaine-related high blood pressure.

My question is are cocaine and methamphetamine really that different in their effects on blood pressure? I know a few people who take atenolol to offset the side effects from meth, is this bad as well or does cocaine cause much worse hypertension than meth?

 

[xxl]

I asked my doctor about this and he didn't think that the combination would be too dangerous at least at low doses,

Emergency ward doctors are warned against ever using beta-blockers against coke-induced hypertension. I once took phentolamine (sold in Brazil under the name Vasoviril as an alternative to Viagra) while hitting the pipe. I didn't know that phentolamine is a beta-blocker of sorts. I had the scariest of tachychardia for about 3 hours!

I don't know about beta-blocker eye-drops (Timol) though. They may be safe because not much goes into the system but even here I'd be careful.

 

[mad_scientist]

If you read the latest research then the picture is not quite so clear cut. It depends what beta blocker is used, and even then the outcome is very variable, with some patients having adverse events from the combination and some showing significant benefits.

The most common beta blocker, propanolol, does seem to be associated with adverse events when combined with cocaine, but some other beta blockers, especially those with mixed alpha/beta antagonist effects seem to be much safer.

beta-Blocker use is associated with coronary artery spasm after cocaine administration but also decreases mortality in patients with myocardial infarction or systolic dysfunction....
...In our cohort, administration of beta-blockers was associated with reduction in incidence of myocardial infarction after cocaine use. The benefit of beta-blockers on myocardial function may offset the risk of coronary artery spasm.

Cocaine and beta-Blockers: Should the Controversy Continue? Robert S. Hoffman, MD. Annals of Emergency Medicine. 2007

Cocaine, Myocardial Infarction, and beta-Blockers: Time to Rethink the Equation? Kalev Freeman, MD, PhD. James A. Feldman, MD, MPH. Annals of Emergency Medicine. 2007

beta-Blockers Are Associated With Reduced Risk of Myocardial Infarction After Cocaine Use. Philip B. Dattilo, MD. Susan M. Hailpern, DrPH, MS. Kerrie Fearon, MD. Davendra Sohal, MD, MPH. Charles Nordin, MD. Annals of Emergency Medicine. 2007

Unfortunately none of these studies looked at atenolol which is the only beta blocker I have access to, but then I can't get coke at the moment either so I'm not worried! But yeah, like I said before and they raised it in one of these articles also, how is cocaine so different to methamphetamine? Sure its more cardiotoxic but the actual effects on blood pressure are pretty similar surely, as they're mediated by the increased monoamine levels. And giving beta blockers to counteract the high blood pressure from meth is fairly well accepted.

Also the other thing is that regardless of whether beta blockers are suitable or not, it seems pretty widely agreed that nitroglycerine is one of the best treatments for cocaine induced hypertension, so does that mean you could just use amyl nitrite? Seeing as thats easy to get, its the only one of these drugs thats easily available without a prescription...

 

[mad_scientist]

Oh yeah also phentolamine is an alpha blocker which is specifically indicated for the treatment of cocaine induced hypertension as an alternative to beta blockers! Which suggests that xxl's tachycardia may have been from too much cocaine rather than an adverse drug interaction...

 

[MDPVagrant]

If you read the latest research then the picture is not quite so clear cut. It depends what beta blocker is used, and even then the outcome is very variable, with some patients having adverse events from the combination and some showing significant benefits.

IMO, a variable outcome like this is enough reason to avoid beta blockers like the plague where cocaine is involved. I mean, how are you gonna know who reacts in what way...

P.S. amyl nitrate is awfully short acting, but unless there's a specific drug-drug interaction it's logical to think it would work... but why not use a longer acting vasodilator instead.

 

[mad_scientist]

Well coke is pretty short acting too, and its not like amyl nitrite is hard to redose if the chest pain comes back. And like I said, amyl nitrite can be bought over the counter so its easy to have some sitting in your cupboard for emergencies, whereas drugs like nitroglycerine or verapamil are prescription only and so will probably be much more difficult to get hold of...if you go to the doctor and say "please can I get a script for verapamil so I can reduce the side effects from my coke binges" then they will probably just tell you not to take the coke!

 

[xxl]

xxl's tachycardia may have been from too much cocaine rather than an adverse drug interaction...

Believe me, I went from no tachychardia at all (never got it from crack, very high tolerance to cardio-vascular effects!) to scary tachychardia. And as soon as my heart started pounding I lay down the pipe and rested but the tachychardia went on for over 2 hours all the same. The effects from the crack were barely noticeable then but the tachychardia went on!

And yes, you're right about phentolamine getting recommended in case of coke-induced hypertension, I remember reading an article to that effect. Fact is, the treatment of a coke seems to be empirical and symtomatic. The worst and most life-threatening symptoms get treated as they appear.

In non emergencies, for preventing hypertension or treating mild hypertension, good old Viagra (+ possibly a bit of Valium) are my ticket. Note that if you're on Viagra, nitros (nitroglycerine, amylnitrite or other "poppers") are a no-no!.

A friend of mine was on "angiotensin inhibitors" (a new generation of hypertension drugs) when he did small lines. But they were very small lines indeed. Asking docs is useless, they will dodge the issue by telling you "better not combine". Even if you ask them if you can combine coke with aspirin they will say "better not".

 

[MDPVagrant]

IME, tachycardia while on cocaine is risky... heart rhythm irregularities seem to develop under this condition. Just casual, non-scientific tests on my lab rats tho.

 

[theWorldWithin]

I think its essentially a no brainer that if you are on any kind of heart medication coke should be avoided. As MDPVagrant pointed out, it is particularly risky in developing long term irregularities if you pay attention to many users reports and retrospectives on coke usage.

 

[MobiusDick]

Your best bet would be an alpha beta blocker like labetolol so that you do not get runaway alpha activity. But IMHO, these examples of problems with beta-blockers may have been in cases where people were already on the verge of or at toxic levels, and the beta blockers were likely non-selective beta1/beta2 blockers and were a poor choice of a mixed physiologic/pharmacologic antagonist to use because of the runaway alpha activity.

But at the end of an evening, if you are OK and you are still suffering from tachycardia after an hour or so post drug use, a Beta1 selective beta-blocker (like metoprolol or atenolol and not propranolol as non-selective beta-blockers often cause rebound tachycardia in people with HTN.) will very likely help decrease BP and HR. It is the non-selective beta-blockers without any alpha-1 activity that are the problem, but these cause problems in people who haven't done cocaine with rebound tachycardia.

MobiusDick

 

[lyXw33d]

Propranolol for tachycardia?

I'm regularly prescribed propranolol (initially for fear of flying, then just for stressful situations as a replacement for benzos). When doing blow, in the rare instance that my bpm actually gets uncomfortably high (around 120, sometimes 140), I'm used to taking 20-40mg propranolol to feel fine again (e.g., I feel a hard pulsing in my neck, the force of the pulse bothering me more than the frequency, take some propranolol -- 15 mins later I feel my pulse, and the pounding is completely gone and I feel fine.

Obviously, this combo does not cause tachycardia in me. Am i still at risk for something? Is this really dangerous (my doc, who's terrified of benzos, tells me propranolol can pretty much be eaten like candy as long as you dont let your bp drop too much)?

 

[lyXw33d]

anyone?

 

[alkap555]

I would say that if you have not experienced any tachycardia then you are probably OK, but personally I would opt for clonidine

 

[lyXw33d]

oo thanks for the tip. sounds like a better solution. anyone else?

 

[rangrz]

clonidine is a good choice. but I've found 10-20mg propanolol works with will with amphetamines or mdpv.

edit: propanolol was what they always gave us in the forces in combo with amphetamine to keep our hands steady for decent aim....

cause between the stress and the amps, you'd get pretty shakey sometimes, and it always got rid of it with no side effects.

 

[lyXw33d]

So is it bad to take 20mg of propranolol with your blow (I never take it more than 2-3 times a day even if im doing the yay all day) or no? Is this something that causes some unseen damage in young, generally healthy (I don't really go to the gym more often than once a month) individuals or what? I'd really appreciate some clarification on the issue... dont want another suspenseful 'swine-flu-like' aprehension experience..

 

[lyXw33d]

anybody?

 

[nuke]

It's hard to tell. In the past beta blockers were strongly recommended against because potentially fatal interactions were thought to exist. However a recent study (one of the quoted above; fulltext in link) states:

β-Blockers Are Associated With Reduced Risk of Myocardial Infarction After Cocaine Use

β-Blocker use is associated with coronary artery spasm after cocaine administration but also decreases mortality in patients with myocardial infarction or systolic dysfunction. We conduct a retrospective cohort study to analyze the safety of β-blockers in patients with positive urine toxicology results for cocaine.
Methods
The cohort consisted of 363 consecutive telemetry and ICU patients who were admitted to a municipal hospital and had positive urine toxicology results for cocaine during a 5-year period (307 patients). Fifteen patients with uncertain history of β-blocker use before admission were excluded. The primary outcome measure was myocardial infarction; secondary outcome measure was inhospital mortality. Logistic regression analysis using generalized estimating equations models and propensity scores compared outcomes.
Results
β-Blockers were given in 60 of 348 admissions. The incidence of myocardial infarction after administration of β-blocker was significantly lower than without treatment (6.1% versus 26.0%; difference in proportion 19.9%; 95% confidence interval [CI] 10.3% to 30.0%). One of 14 deaths occurred in patients who received β-blockade (incidence 1.7% versus 4.5% without β-blockade; difference in proportion 2.8%; 95% CI –1.2% to 6.7%). Multivariate analysis showed that use of β-blockers significantly reduced the risk of myocardial infarction (odds ratio 0.06; 95% CI 0.01 to 0.61).
Conclusion
In our cohort, administration of β-blockers was associated with reduction in incidence of myocardial infarction after cocaine use. The benefit of β-blockers on myocardial function may offset the risk of coronary artery spasm.

http://docs.google.com/Doc?id=dcj5m3nc_21g9qb7vdr

So, it may not be any more dangerous than doing a lot of cocaine (which is actually very dangerous because of cocaine's unpreventable cardiotoxicity). Cocaine causes fatalities mainly due to causing coronary artery spasms related to its local anaesthetic effect. You're probably a lot safer off just taking amphetamine or methylphenidate.

 

[Jprc11]

Hello I recently had a bit of a problem after an extended session on ice I went to the hospital with what I thought was stroke (cobweb feelings on left side of face hand and horizontal vein/artery under the naval)one injection I was good as new , now I have propranolol and lorazepa in your opinion safe to take if I get an anxiety attack or whatever again ? Any answer is appreciated cheers