The use of labetalol in the management of cocaine crisis

doi:10.1016/S0196-0644(88)80124-0

Annals of Emergency Medicine

Volume 17, Issue 3, March 1988, Pages 282-283

https://doi.org/10.1016/S0196-0644(88)80124-0 Get rights and content

We report a case of successful resuscitation and clinical management in a 31-year-old man who allegedly ingested 20 g of cocaine hydrochloride. The physiologic and pharmacologic mechanisms of cocaine toxicity are reviewed. The use of labetalol in resolving the cardiovascular crisis is specifically detailed.

References (10)

JonssonS et al.
Acute cocaine poisonings: Importance of treating seizures and acidosis
Am J Med
(1983)
GayGR
Clinical management of acute and chronic cocaine poisoning
Ann Emerg Med
(1982)
RamoskaE et al.
Propranolol-induced hypertension in treatment of cocaine intoxication
Ann Emerg Med
(1985)
BozarthMA et al.
Toxicity associated with long-term intravenous heroin and cocaine administration in the rat
JAMA
(1985)
RitchieJM et al.
Local anesthetics

There are more references available in the full text version of this article.

Cited by (84)

Overdose of cardiotoxic drugs
2018, Cardiac Intensive Care
Acute Toxicity from Topical Cocaine for Epistaxis: Treatment with Labetalol
2017, Journal of Emergency Medicine
Citation Excerpt :
Standard practice in these clinical situations entails the use of benzodiazepines, titrated to alleviate anxiety and central nervous system sympathetic outflow. The successful use of the mixed β/α-blocker labetalol in the setting of cocaine toxicity has been previously described (16–18). Our case report is the first to detail the novel use of labetalol in lieu of benzodiazepines to treat immediate cocaine toxicity from iatrogenic topical use in an emergency department setting.
Topical cocaine is sometimes used for the treatment of epistaxis, as it has both potent anesthetic and vasoconstrictive properties. Cocaine has unpredictable cardiovascular effects, such as sudden hypertension, tachycardia, coronary arterial vasoconstriction, and dysrhythmia.
We report a case of acute iatrogenic cardiovascular toxicity from the use of topical cocaine in a 56-year-old man presenting to the Emergency Department with profound epistaxis. To prepare for cauterization and nasal packing, the patient received 4% topical cocaine-soaked nasal pledgets. He became hypertensive, tachypneic, tachycardic, and dysphoric immediately after administration. To directly counter these adverse hyperadrenergic effects, the patient was given 10 mg intravenous labetalol, a mixed β- and α-blocker. This instantly normalized his vital signs and adverse subjective effects. His epistaxis was successfully treated, and he was discharged 1 h later.
We believe that emergency physicians should be aware of the unpredictable acute cardiovascular toxicity of topical cocaine. Labetalol represents an effective first-line treatment, which, unlike benzodiazepines, directly counters the pharmacologic effects of cocaine and has no respiratory or sedative side effects. Labetalol, with its mixed β/α-blocking properties, also mitigates the potential for “unopposed α-stimulation.”
Dual cocaine and methamphetamine cardiovascular toxicity: rapid resolution with labetalol
2017, American Journal of Emergency Medicine
Hypertensive emergencies
2010, Cardiac Intensive Care: Expert Consult
Overdose of cardiotoxic drugs
2010, Cardiac Intensive Care: Expert Consult
Overdose of Cardiotoxic Drugs
2010, Cardiac Intensive Care

View all citing articles on Scopus

View full text

Case reportThe use of labetalol in the management of cocaine crisis

Am J Med

Ann Emerg Med

Ann Emerg Med

Toxicity associated with long-term intravenous heroin and cocaine administration in the rat

JAMA

Local anesthetics

Case report
The use of labetalol in the management of cocaine crisis