College of Pharmacy
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HelixTalk Episode #118 - Cocaine and Beta-blockers: Absolute Contraindication or Medical Myth?
Date posted: September 8, 2020, 6:00 am
In this episode, we discuss the proposed risks of using beta blockers in patients with cocaine use disorders and whether evidence supports this drug interaction as an “absolute” contraindication.
- Cocaine causes vasoconstriction via the alpha-1 receptor. Normally some of this vasoconstriction is offset by the beta-2 receptor, which causes opposing vasodilation. There is a theoretical concern that combining cocaine with beta blockers could lead to “unopposed alpha” activation and profound hypertension.
- There is very little data supporting the “unopposed alpha” theory. Of the data available, most implicates propranolol but not other beta blockers as potentially being harmful when used with cocaine.
- Larger, retrospective studies and meta-analyses suggest that there are no harmful effects of using beta blockers in patients with cocaine use disorders, especially in patients with cocaine-associated chest pain or those with heart failure with reduced ejection fraction.
- While this topic is still controversial, the best available evidence suggests this theoretical interaction is a medical myth and should not lead to withholding beta blocker therapy in patients with clear indications.
- Richards JR, Hollander JE, Ramoska EA, et al. β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon. J Cardiovasc Pharmacol Ther. 2017;22(3):239-249. doi:10.1177/1074248416681644
- Pham D, Addison D, Kayani W, et al. Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis. Emerg Med J. 2018;35(9):559-563. doi:10.1136/emermed-2017-207065
- Mann BK, Bhandohal JS, Saeed M, Pekler G. Beta Blocker Therapy in Heart Failure Patients with Active Cocaine Use: A Systematic Review. Cardiol Res Pract. 2020;2020:1985379. Published 2020 May 8. doi:10.1155/2020/1985379