Brief ReportsA prospective, randomized, controlled trial of benzodiazepines and nitroglycerine or nitroglycerine alone in the treatment of cocaine-associated acute coronary syndromes☆,☆☆
Section snippets
Methods
A convenience sample of all patients who presented to the ED of our institution with chest pain and self-reported cocaine use in the preceding 72 hours was enrolled between November, 1998 and December, 1999. The institution is a large, urban teaching hospital with an emergency department census of 96,000. Most patients served by this ED are uninsured (39%) or have Medicaid (22%). The ED is staffed by board-certified emergency physicians who supervise emergency medicine residents and physician
Results
A total of 36 patients were enrolled in the study. Nine patients were excluded because they met the study exclusion criteria. These included 5 patients who were older than 44 years, 1 who was 17 years old, 1 who had chest pain for approximately 4 days, 1 who received NTG from emergency medical services personnel, and 1 who took propranolol for hypertension.
Group 1, treated with NTG only, consisted of 15 patients, and group 2, treated with NTG plus lorazepam, consisted of 12 patients. The
Discussion
The results of this study indicate that the early use of lorazepam together with NTG was more efficacious than NTG alone in relieving cocaine-associated chest pain in humans. In this study, lorazepam appeared to be safe in the early management of cocaine- associated chest pain.
Although the exact mechanism of chest pain in the setting of cocaine use is unknown, an increased sympathomimetic response is thought to induce coronary vasoconstriction. This has been shown to be reversible in the
References (24)
Platelets and thrombogenesis—current concepts
Am Heart J
(1972)- et al.
The cardiovascular effects of cocaine
Ann Emerg Med
(1991) - et al.
The effects of cocaine on human platelets in healthy subjects
Am J Cardiol
(1993) - et al.
Cocaine associated myocardial infarction study group
Chest
(1995) The management of cocaine induced myocardial ischemia
N Engl J Med
(1995)- et al.
Prospective multicenter evaluation of cocaine associated chest pain. Cocaine associated chest pain (COCHPA) study group
Acad Emerg Med.
(1994) - Tokarski GF, Paganussi P, Urbanski R,et al: An evaluation of cocaine-induced chest pain Ann Emerg Med...
- et al.
Cocaine induced coronary vasoconstriction
N Engl J Med
(1989) - et al.
Coronary-artery vasoconstriction induced by cocaine, cigarette smoking, or both
N Engl J Med
(1994) - et al.
Platelet responsiveness and biosynthesis of thromboxane and prostacyclin in response to in vitro cocaine treatment
Hemostasis
(1985)
Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade
Ann Intern Med
Second American Heart Association International Evidence Evaluation Conference; Part 6: Advanced Cardiovascular Life Support; Section 1: Introduction to ACLS 2000: Overview of Recommended Changes in ACLS From the Guidelines 2000 Conference
Circulation
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Acute Cardiovascular Toxicity of Cocaine
2022, Canadian Journal of CardiologyCitation Excerpt :Benzodiazepines are included as first-line therapy in patients with cocaine-associated chest pain, specifically in those patients manifesting features of increased sympathetic tone, including anxiousness, hypertension, and tachycardia.89,104 Nitroglycerin has been shown to decrease chest pain in patients presenting with cocaine-associated symptoms.55,66 Cardiac catheterisation studies have demonstrated the ability of nitroglycerin to reverse the coronary artery vasoconstriction caused by cocaine.15
Drugs of Abuse and Cardiotoxicity
2018, Comprehensive Toxicology: Third EditionTreatment of toxicity from amphetamines, related derivatives, and analogues: A systematic clinical review
2015, Drug and Alcohol DependenceCitation Excerpt :There were no high-quality studies of benzodiazepines for treatment of ARDA-associated hyperadrenergic state. Two level I studies of cocaine-induced chest pain compared benzodiazepines to nitroglycerin, with dual therapy having advantage over single therapy in one study (Honderick et al., 2003). In the other trial there was no difference between dual versus single agent therapy (Baumann et al., 2000).
Intravenous methylphenidate: An unusual way to provoke ST-elevation myocardial infarction
2015, American Journal of Emergency Medicine
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Address reprint requests to David C. Seaberg, MD, Department of Emergency Medicine, University of Florida Health Science Center, PO Box 100186, Gainesville, FL 32610-0186. E-mail: [email protected]
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