β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon

John R. Richards, Judd E. Hollander, Edward A. Ramoska, Fareed N. Fareed, I. Charles Sand, María Manuela Izquierdo Gómez, Richard A. Lange

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations

Abstract

Cocaine abuse remains a significant worldwide health problem. Patients with cardiovascular toxicity from cocaine abuse frequently present to the emergency department for treatment. These patients may be tachycardic, hypertensive, agitated, and have chest pain. Several pharmacological options exist for treatment of cocaine-induced cardiovascular toxicity. For the past 3 decades, the phenomenon of unopposed α-stimulation after β-blocker use in cocaine-positive patients has been cited as an absolute contraindication, despite limited and inconsistent clinical evidence. In this review, the authors of the original studies, case reports, and systematic review in which unopposed α-stimulation was believed to be a factor investigate the pathophysiology, pharmacology, and published evidence behind the unopposed α-stimulation phenomenon. We also investigate other potential explanations for unopposed α-stimulation, including the unique and deleterious pharmacologic properties of cocaine in the absence of β-blockers. The safety and efficacy of the mixed β-/α-blockers labetalol and carvedilol are also discussed in relation to unopposed α-stimulation.

Original languageEnglish (US)
Pages (from-to)239-249
Number of pages11
JournalJournal of Cardiovascular Pharmacology and Therapeutics
Volume22
Issue number3
DOIs
StatePublished - May 1 2017
Externally publishedYes

Keywords

  • cardiovascular
  • cocaine
  • toxicity
  • unopposed
  • vasoconstriction
  • α
  • β-blocker

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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