cardiovascular-agents and Cocaine-Related-Disorders

Topics: Adolescent; Adult; Algorithms; Angioplasty, Balloon, Coronary; Benzodiazepines; Cardiovascular Agents; Chest Pain; Cocaine; Cocaine-Related Disorders; Combined Modality Therapy; Coronary Circulation; Diagnostic Imaging; Disease Management; Evidence-Based Medicine; Female; Humans; Male; Myocardial Infarction; Platelet Aggregation Inhibitors; Smoking; Sympathomimetics; Thrombophilia; Vasoconstrictor Agents

Topics: Angina Pectoris; Cardiovascular Agents; Cocaine; Cocaine-Related Disorders; Diagnosis, Differential; Electrocardiography; Humans; Male; Middle Aged; Sympathomimetics; Vasoconstrictor Agents

Cocaine use is associated with increased cardiovascular mortality and can promote acute coronary syndrome (ACS). Use of beta-blockers is controversial in patients who use cocaine, and the safety and efficacy of these medications in ACS in patients actively using cocaine is unknown. We enrolled 90 patients with ACS and positive urine drug screen for cocaine. Patients received standard ACS therapy plus either labetalol (n = 60) or diltiazem (n = 30). Blood pressure and heart rate were measured at baseline and 48 hours. Levels of serum CD40 ligand, interleukin (IL)-6, and choline at baseline and 48 hours were determined. There were no baseline differences in hemodynamics or serum levels of inflammatory markers between the labetalol and diltiazem groups. Both groups experienced a significant and equivalent decrease in BP and HR at 48 hours compared with baseline. At 48 hours of treatment, there were significant decreases of 17% in CD40 ligand (P < .005) and 16% in IL-6 (P < .005) but no change in choline in the diltiazem group. Furthermore, in the labetalol group, there were significant differences of 30% in CD40 ligand (P < .005 time and group comparison), 22% in IL-6 (P < .005 time and group comparison), and 18% in choline (P < .005 time and group comparison). There were no adverse events during hospitalization in any patients who received labetalol. In conclusion, labetalol appears to be safe in cocaine-associated ACS. Furthermore, labetalol provides a beneficial hemodynamic response and, in comparison to diltiazem, potentiates an anti-inflammatory vascular response in this setting.

Topics: Acute Coronary Syndrome; Adrenergic alpha-Antagonists; Adult; Aged; Biomarkers; Cardiovascular Agents; CD40 Ligand; Cocaine-Related Disorders; Diltiazem; Female; Georgia; Hemodynamics; Humans; Inflammation; Interleukin-6; Labetalol; Male; Middle Aged; Treatment Outcome

Priapism is a urologic disorder and medical emergency with a variety of known etiologies including the use of psychotropic medications. The antidepressant trazodone is the agent most frequently implicated in the precipitation of priapism. Additionally, a number of drugs of abuse including marijuana, ethanol, and cocaine have been known to cause the disorder. It is unknown if drugs may act in an additive or a synergistic manner to cause priapism. We report a case of priapism which occurred following trazodone overdose in an individual actively using cocaine. This case suggests that combined trazodone and cocaine use may pose an additional risk of priapism. Since trazodone is commonly employed as a hypnotic and often chosen for polysubstance abusers due to its low abuse potential, clinicians should be aware of the possible additive risk of priapism in this patient population.

Topics: Adult; Cardiovascular Agents; Cocaine; Cocaine-Related Disorders; Drug Interactions; Drug Overdose; Humans; Male; Narcotics; Priapism; Selective Serotonin Reuptake Inhibitors; Suicide, Attempted; Trazodone