Mark Walsh, MD; Jeff Atwood, MD
To the Editor: Robin and colleagues (1) showed that propranolol blunts the pulmonary edema and ascites in mice given massive doses of cocaine. They suggest that their findings in this animal model can be applied to the clinical setting of cocaine overdosage. However, propranolol has been reported (2, 3) to cause paradoxical worsening of cocaine-induced hypertension. Unopposed alpha-adrenergic receptor stimulation after beta-adrenergic blockage by propranolol results in greater hypertension. On the other hand, alpha-II and beta-adrenergic blockage with labetolol has been used successfully to treat the hypertension and tachyarrhythmias caused by cocaine. For these reasons it is premature to propose
Walsh M, Atwood J. Cocaine, Pulmonary Edema, and Propranolol. Ann Intern Med. ;110:843–844. doi: 10.7326/0003-4819-110-10-843_2
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Published: Ann Intern Med. 1989;110(10):843-844.
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