Which medications may worsen the adverse effects of cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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Medications commonly administered to treat pathophysiologic effects of cocaine may worsen other adverse effects of cocaine. Thus, there is concern primarily about use of epinephrine, lidocaine, and beta-blockers in the setting of acute cocaine toxicity. Conflicting reports and recommendations in the literature compound the controversy.

As an example, the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care acknowledge that many toxicologic approaches are not based on high-quality research, but rather on case reports, small case series, and data extrapolated from animal studies. [46] The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) 2014 recommendations for treatment of patients with cocaine toxicity are based on class C evidence  (ie, consensus opinion of experts, case studies, or standard of care). [47]

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