0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

β-Blockers and Cocaine: Still a Bad Idea—Reply

Carlos Rangel; Gregory M. Marcus, MD, MAS
Arch Intern Med. 2010;170(20):1859-1860. doi:10.1001/archinternmed.2010.399.
Text Size: A A A
Published online

Extract

In reply

We appreciate the comments provided by Canning et al. While we agree that it is possible that patients with cocaine-related chest pain with greater sympathomimetic activity may react differently to BB administration, we found no evidence of this in our study. In addition, the blood pressure response on average was substantially reduced after BBs were given, with no evidence that the BBs induced any hypertensive urgencies or emergencies. Canning et al raise an important issue related to methamphetamine use. While the pathophysiologic changes and response to BBs may be similar to those with recent cocaine ingestion, our study did not address the safety of BBs in the setting of methamphetamine use. Future studies aimed at elucidating the risks (and potential benefits) of BBs in cocaine and/or amphetamine users with different levels of sympathomimetic-induced toxicity will indeed be important. Finally, we agree that there is likely little downside to using nonselective BBs, such as carvedilol, in these patients. However, cost, the availability of intravenous formulations, potential differences in blood pressure response, and, if prescribing for long-term outpatient use, differences in tolerability should be considered.

Topics

cocaine

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

24 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();