Clin Exp Emerg Med.  2019 Mar;6(1):84-88. 10.15441/ceem.17.247.

Metoprolol treatment of dual cocaine and bupropion cardiovascular and central nervous system toxicity

Affiliations
  • 1Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA. jrrichards@ucdavis.edu
  • 2Department of Family & Community Medicine, University of California Davis Medical Center, Sacramento, CA, USA.
  • 3Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA.
  • 4Division of Toxicology, University of California Davis Medical Center, Sacramento, CA, USA.
  • 5Division of Pulmonary and Critical Care, University of California Davis Medical Center, Sacramento, CA, USA.

Abstract

Cardiovascular and central nervous system (CNS) toxicity, including tachydysrhythmia, agitation, and seizures, may arise from cocaine or bupropion use. We report acute toxicity from the concomitant use of cocaine and bupropion in a 25-year-old female. She arrived agitated and uncooperative, with a history of possible antecedent cocaine use. Her electrocardiogram demonstrated tachycardia at 130 beats/min, with a corrected QT interval of 579 ms. Two doses of 5 mg intravenous metoprolol were administered, which resolved the agitation, tachydysrhythmia, and corrected QT interval prolongation. Her comprehensive toxicology screen returned positive for both cocaine and bupropion. We believe clinicians should be aware of the potential for synergistic cardiovascular and CNS toxicity from concomitant cocaine and bupropion use. Metoprolol may represent an effective initial treatment. Unlike benzodiazepines, metoprolol directly counters the pharmacologic effects of stimulants without respiratory depression, sedation, or paradoxical agitation. A lipophilic beta-blocker, metoprolol has good penetration of the CNS and can counter stimulant-induced agitation.

Keyword

Cocaine; Bupropion; Toxicity; Beta-blocker; Metoprolol

MeSH Terms

Adult
Benzodiazepines
Bupropion*
Central Nervous System*
Cocaine*
Dihydroergotamine
Electrocardiography
Female
Humans
Metoprolol*
Respiratory Insufficiency
Seizures
Tachycardia
Toxicology
Benzodiazepines
Bupropion
Cocaine
Dihydroergotamine
Metoprolol
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