How is acute coronary syndrome (ACS) treated in cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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The AHA guidelines note that clear evidence exists that cocaine can precipitate acute coronary syndrome (ACS), and it may be reasonable to try agents that have shown efficacy in the management of ACS in patients with severe cardiovascular toxicity. Agents that may be used as needed to control hypertension, tachycardia, and agitation include the following [46] :

  • Alpha-blockers (phentolamine)
  • Benzodiazepines (lorazepam, diazepam)
  • Calcium channel blockers (verapamil)
  • Morphine
  • Sublingual nitroglycerin (NTG)

The AHA does not recommend any one of those agents over another in the treatment of cardiovascular toxicity due to cocaine, but benzodiazepines should usually be first line.

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