How is hypertension treatment in cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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Cocaine may precipitate hypertensive emergency due to CNS stimulation and peripheral alpha-agonist effects. Toxicity may be superimposed on preexisting hypertension in patients who have become dependent on elevated BP to maintain cerebral perfusion. Carefully consider the patient's clinical status and history when deciding to treat hypertension.

Hypertension secondary to cocaine is commonly responsive to intravenous benzodiazepines, because benzodiazepines minimize the stimulant effects of cocaine on the CNS.

A vasodilator, such as NTG or nitroprusside, may be titrated to effect if further therapy is indicated, and phentolamine may be considered. NTG is the drug of choice in patients with chest pain. The use of nitroprusside to control hypertension has the additional advantage of aiding heat loss by peripheral vasodilatation.

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