Beta-Blockers for Cocaine and other Stimulant Toxicity

Dogma: “a belief or set of beliefs that is accepted by the members of a group without being questioned or doubted; a point of view or tenet put forth as authoritative without adequate grounds.” Years ago I treated a university student who presented to the emergency department (ED) after drinking several cans of a popular caffeinated energy drink to “pull an all-nighter” during final exam week. He was tremulous, agitated, and pale, with sinus tachycardia ranging from 140 to 160 bpm and normal blood pressure (BP). The house officer (registrar) working with me that night proposed treating him with a benzodiazepine, but I pointed out he had an important exam to take in a few hours and had driven himself to the ED. Rather than snow him with benzos, I suggested metoprolol, a lipophilic beta-1 blocker with both peripheral and central nervous system effects. Her response to this was, “Oh no, you can’t do that – what about unopposed-alpha stimulation?” It was at this point I realized the level of misinformation regarding this dogma had become so pervasive, that newly-minted physicians were applying it as an absolute contraindication to beta-blocker treatment for all stimulants. I asked her, “What is unopposed alpha-stimulation?” She replied, “It’s where you give a beta-blocker and their BP immediately skyrockets.” I asked some other house officers nearby: “It’s when they get an arrhythmia after beta-blockers,” and, “They get chest pain and MI right af...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Toxicology and Toxinology alpha stimulation amphetamines Beta Blockers cocaine dogma John Richards Stimulant Toxicity Stimulants Source Type: blogs