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Rappolt RT, Gay G, Inaba DS, Rappolt N.
“Use of Inderal (Propranolol-Ayerst) in 1-a (Early Stimulative) and 1-b (Advanced Stimulative) Classification of Cocaine and Other Sympathomimetic Reactions”.
Clin.Toxicol.. 1978;13(2):325-32.
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Abstract
The use of propranolol (PP) in cocaine (C) overdosage and other sympathomimetic reactions is reviewed. The hyperkinetic reaction induced by chronic nasal or i.v. C (3-14 days) may be attenuated, and possible death averted, by PP. Concomitant antiemetics will control nausea. A case report is given of a rock musician with a history of heavy C use who presented a few min after his last i.v. dose with symptoms of adrenergic overstimulation. He was given PP (6 ma, at 1 ma/ min). Heart rate, B.P. and respiratory frequency were almost normal after 10 min. but pupils remained dilated and mucous membranes dry. He received 10 mg i.v. perchloperazine (Compazine), which relieved retching in 3-5 min. 30 Min after presenting, he was almost free of signs and symptoms, and after a further 30 min he was able to perform. Diazepam (Valium) was prescribed to be taken over the following day. Recreational C users have reported a comfortable 'high' on nasal or i.v. C after pretreatment with 40 mg PP, but this has led to side effects (hyperpyrexia, dyspnea, headache and diastolic hypertension, the last not increasing if 0.2-0.4 mg clonidine is given with the PP). Therapeutic roles of PP, and its mode of action, are discussed. PP has been used in arrhythmias, angina, hypertension, amphetamine intoxication, thyrotoxic hypercalcemia, thyroid storm, pheochromocytoma, 'lithium tremor', 'action' tremor and migraine. It is also useful in treating ethanol reactions with Antabuse or Corpinus mushrooms, niacin-induced flush, tricyclic antidepressant-MAO inhibitor hyperpressor storms, doxapram-induced hypertension and acute ethanol withdrawal syndrome. It alleviates CNS disorientation after LSD or phencyclidine (the effects of the latter are also reported to be modified by haloperidol). It is predicted that PP may be useful in 'degreaser's flush' and in Maneb and Zineb herbicide, caffeine, yohimbine and ibogaine intoxications. The 'quinidine-like' activity of PP may also have a therapeutic role. PP overdosage may be treated with activated charcoal, atropine, and isoproterenol (Isuprel; Winthrop).
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