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• Author response to e-Letter by Dr. Fayomi
  David Wood
  Published on: 29 April 2016
• Management of Cocaine Associated Chest Pain
  Olu Fayomi
  Published on: 29 April 2016

• Published on: 29 April 2016

  Author response to e-Letter by Dr. Fayomi

  • David Wood, Guy's and St Thomas' Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, London
  • Other Contributors:
    • Paul Dargan, Guy's and St Thomas' Poisons Unit, Guy's and St Thomas' NHS Foundation Trust, London

  Dear Editor,

  In his letter, Fayomi states correctly that the use of beta-blockers in the management of cocaine-related acute coronary syndrome is contraindicated (1). We feel, however, that Fayomi has mis-interpreted the information in Table 1, by believing that the authors are advocating the use of beta-blockers in the management of cocaine-related chest pain. The authors have clearly highlighted in the first...

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  Dear Editor,

  In his letter, Fayomi states correctly that the use of beta-blockers in the management of cocaine-related acute coronary syndrome is contraindicated (1). We feel, however, that Fayomi has mis-interpreted the information in Table 1, by believing that the authors are advocating the use of beta-blockers in the management of cocaine-related chest pain. The authors have clearly highlighted in the first paragraph on page 823 of the manuscript, that the use of beta-blockers in the management of cocaine -related chest pain (2). The authors have also stated this in other work that they have published relating to cocaine-related chest pain and other cocaine-related toxicity (3,4,5).

  For each of the clinical scenarios in table 1, those participating in the study were asked to state if the antidote/treatment and route of administration were correct; for some of the scenarios an inappropriate antidote/treatment and/or route of administration was stated. Those participating scored a correct mark for those scenarios where the antidote/treatment and/or route of administration was incorrect if they correctly identified this. The scenario of cocaine-related chest pain and the suggested antidote/treatment of IV Metoprolol was one of the scenarios in Table 1 in which an inappropriate antidote/treatment was suggested, and therefore the correct answer for this scenario was for participants to state that this was incorrect.

  References:

  1. Fayomi O. Management of Cocaine Associated Chest Pain. EMJ on line http://emj.bmj.com/cgi/eletters/25/12/820 (last accessed 23rd December 2008).

  2. Lidder S, Ovaska H, Archer JR, Greene SL, Jones AL, Dargan PI, Wood DM. Doctors' knowledge of the appropriate use and route of administration of antidotes in the management of recreational drug toxicity. Emerg Med J. 2008; 25: 820-3

  3. Wood DM, Hill D, Gunasekera A, Greene SL, Jones AL, Dargan PI. Is cocaine use recognised as a risk factor for acute coronary syndrome by doctors in the UK? Postgrad Med J. 2007; 83: 325-8

  4. Greene SL, Dargan PI, Jones AL. Acute poisoning: understanding 90% of cases in a nutshell. Postgrad Med J. 2005; 81: 204-16.

  5. Wood DM, Dargan PI, Hoffman RS. Management of cocaine-induced cardiac arrhythmias due to cardiac ion channel dysfunction. Clin Toxicol (Phila). 2008 Sep 24:1-10. [Epub ahead of print]

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  Conflict of Interest:
  None declared.

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• Published on: 29 April 2016

  Management of Cocaine Associated Chest Pain

  • Olu Fayomi

  Dear Sir,

  I read with great interest the article by Liddler et al on the appropriate use and administration of antidotes for recreational drug toxicity. I would however like to seek clarification from the authors for their justification in the use of iv Metoprolol in scenario 4 ( 42 – Year old man with ingestion of two lines of cocaine presenting with ischaemic chest pain, ECG changes-ST depression and a BP of...

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  Dear Sir,

  I read with great interest the article by Liddler et al on the appropriate use and administration of antidotes for recreational drug toxicity. I would however like to seek clarification from the authors for their justification in the use of iv Metoprolol in scenario 4 ( 42 – Year old man with ingestion of two lines of cocaine presenting with ischaemic chest pain, ECG changes-ST depression and a BP of 175/95mm Hg). Use of beta blockers in this situation is contraindicated, as stated in a recent scientific statement from American Heart Association1. and a point that the authors acknowledge in the discussion section of their article. Given the current widespread recreational use of cocaine in the UK and that it is reported that up to 40% of cocaine users who present to the ED report chest pain, I would thank the authors for addressing this important clinical management point.

  References:

  1. Management of Cocaine-Associated Chest Pain and Myocardial Infarction: A Scientific Statement From the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. McCord J, Jneid H, Hollander JE, et al. Circulation. 2008;117:1897-1907

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  Conflict of Interest:
  None declared.

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