Modern beta-blockers

[slickbee]

Greetings!

I did quite a lot of research on subject of stimulants and beta-blockers and I know that doing coke (and other stims) while being on beta-blockers is a no-no, because of unopposed alpha stimulation. But this theory was crafted (and is questioned by some) in the era of early generation beta-blockers, like Propranolol, which were non-selective and inferior to what is out there on the market right now.

So, does the same rule apply to modern, highly selective beta-blockers, like Bystolic (Nebivolol)?

I'm on 2,5mg/day of Nebivolol (not Bystolic itself, but a drug with Nebivolol under the hood) because my blood pressure was floating between prehypertension and stage 1 hypertension. After 2 months of Nebivolol now it's floating between normal and prehypertension (never exceeding 140/90) and I was wondering how much of a risk I'd put myself in when going on a one night coke binge once/twice a year?

 

[Slow_Mobius]

Ehhh it's alot more risky. The risk with beta blockers is often overstated, but youre playing with fire regardless. Honestly, if you have cardiovascular issues, you should be avoiding coke anyways, and if you do happen to OD, you could face potentially life threatening consequences. When I was taking beta-blockers, any stim use would usually send me into a near-panic attack worrying about my heart, so it really wasn't fun anyways. I would avoid it

 

[Kittycat5]

In the name of HR, I agree with the above but in reality, I think you most likely would be fine. Ive read articles debating the whole dont use beta blockers in stimulant overdose theory and while still absolutely not the norm in emergency care of real stimulant toxicity, a low dose of a cardioselective beta blocker and non-toxic levels of cocaine shouldnt cause major issues in most. Few caveats though. Nebivolol loses cardioselective properties at higher doses and of course coke is the father of moreish drugs.

 

[Slow_Mobius]

In the name of HR, I agree with the above but in reality, I think you most likely would be fine. Ive read articles debating the whole dont use beta blockers in stimulant overdose theory and while still absolutely not the norm in emergency care of real stimulant toxicity, a low dose of a cardioselective beta blocker and non-toxic levels of cocaine shouldnt cause major issues in most. Few caveats though. Nebivolol loses cardioselective properties at higher doses and of course coke is the father of moreish drugs.

At my school they still teach the med students not to do it, but it really only becomes an issue of the person is overdosing on simulants and nearing hypertensive crisis. But I'll usually default to the safest advice, and this case it's avoiding the combo. Like KC said, its probably fine, but it can cause serious problems if they're overdone

 

[kleinerkiffer]

I feel like this is a more advanced question, so I'll move it to Neuroscience and Pharmacology Discussion

 

[CFC]

As said, ideally you should avoid coke, given your pre-existing issues.

However your BP is a little high anyway even on nebivolol. So you could discuss a prescription of carvedilol or labetalol with your GP/specialist. These two block postsynaptic α1 as well as β1 and β2, which may improve your response to β-blockers in general and, as per your question, attenuate the risk of alpha-receptor stimulated reflex tachycardia/arterial vasoconstriction when using coke + β-blocker.

Bear in mind, though, that many people find even the most selective β-blockers can blunt the positive sides of coke/amps, and this is even moreso the case for α1 blockers. They're thus generally more useful during comedown.