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. 2019 Mar;6(1):84-88.
doi: 10.15441/ceem.17.247. Epub 2018 Jan 31.

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

John R Richards  1 , Jessica B Gould  2 , Erik G Laurin  1 , Timothy E Albertson  3
Affiliations

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

John R Richards et al. Clin Exp Emerg Med. 2019 Mar.

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.

Keywords: Beta-blocker; Bupropion; Cocaine; Metoprolol; Toxicity.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Electrocardiogram performed shortly after arrival (rate, 130 beats/min; PR interval, 104 ms; QRS duration, 108 ms; corrected QT interval, 579 ms).
Fig. 2.
Fig. 2.
Electrocardiogram performed 10 minutes after receiving metoprolol (rate, 89 beats/min; PR interval, 174 ms; QRS duration, 110 ms; corrected QT interval, 489 ms).
See this image and copyright information in PMC

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