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User:WikiLinuz/Psychoactive substances/Psychostimulants adverse reaction reduction

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Selective and non-selective Beta blockers

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  • Patients who use stimulants such as crystal methamphetamine and cocaine often have cardiovascular conditions for which β-blockers are part of the standard of care.
  • Many clinicians are hesitant to prescribe β-blockers in the setting of active stimulant use owing to a perceived risk of “unopposed α-receptor stimulation.”
  • Evidence does not support a high risk of harms from the combination of β-blockers and stimulants, and the best available evidence suggests long-term β-blockers are safe in the context of stimulant use.
  • Until there is clear evidence of harm, patients with stimulant use disorder and concurrent cardiac comorbidities deserve to be offered the standard of care, including discussion on the risks and benefits of β-blocker therapy.
    — Tyler W, Ian P, Paxton B (31 January 2022). "Avoidance of β-blockers in patients who use stimulants is not supported by good evidence". Canadian Medical Association Journal. 194 (4). doi:10.1503/cmaj.211347. PMID 35101873.


Treatment of Arrhythmias in Patients With Cocaine Use:
Experimental studies and some case reports indicate that beta-blocker use can lead to unopposed alpha-adrenergic actions of cocaine producing severe hypertension, coronary vasospasm, and death. However, a recent meta-analysis reported no difference in outcomes in active cocaine users started on a beta-blocker to treat hypertension, chest pain or tachycardia versus those who were not.53 The authors concluded unopposed alpha-agonistic actions are probably very rare and likely because of myriad effects of cocaine itself rather than concomitant beta-blocker use.54 Use of labetalol and carvedilol may be preferred as they can act as alpha blockers as well.
— Paari D, Javaria A, Hajra A, Shenuarin B, Christopher K, Nicholas G, Kevin M, James P, Kristin S, Rakesh G, Brian O (28 December 2021). "Stimulant Drugs of Abuse and Cardiac Arrhythmias". Circulation: Arrhythmia and Electrophysiology. 15 (1). doi:10.1161/CIRCEP.121.010273. PMC 8766923. PMID 34961335.


Benzodiazepines

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