title: Controversial therapeutics: the β-adrenergic antagonist and cocaine-associated cardiovascular complications dilemma.
abstract: Cocaine abuse is associated with cardiovascular complications that include chest pain and myocardial infarction. Traditional therapy for these conditions includes a β-adrenergic antagonist. However, guidelines released in 2008 recommended against this treatment option because of the prevailing theory that cocaine will potentiate vasospasm secondary to unopposed α-adrenergic effects. Subsequently, further evidence and updated guidelines have become available, debunking this claim. Current literature is limited but suggests that β-adrenergic antagonists are harmful. Although case reports support a detrimental effect of β-adrenergic antagonists, the anecdotal data are inconsistent, and the conclusions from case studies are overruled by larger studies. The pharmacology, pathophysiology, and literature on the use of β-adrenergic antagonists in association with cocaine are reviewed. Future studies that focus on outcomes and different pharmacologic profiles of β-adrenergic antagonists are needed.
authors.affiliation: St. John's University College of Pharmacy and Health Sciences, Queens, New York.
authors.forename: James W
authors.initials: JW
authors.lastname: Schurr
authors.forename: Brenda
authors.initials: B
authors.lastname: Gitman
authors.forename: Yuly
authors.initials: Y
authors.lastname: Belchikov
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D003042:Cocaine / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D019970:Cocaine-Related Disorders / Q000150:complications; D004347:Drug Interactions; D006801:Humans
chemical_list: D000319:Adrenergic beta-Antagonists; D003042:Cocaine
keywords: cardiology; chest pain; cocaine; drug abuse; myocardial infarction; toxicology; β-blocker