In the management of agitation from cocaine intoxication, which therapy is not recommended?

• A. Benzodiazepines
• B. Antipsychotics
• C. Supportive care
• D. Beta blockers

Answer: (D)

Beta-blockers are not recommended in the management of agitation from cocaine intoxication because they can worsen the problem by allowing unopposed alpha-adrenergic activity. Cocaine increases sympathetic outflow by blocking the reuptake of norepinephrine, leading to intense alpha-mediated vasoconstriction and potential coronary vasospasm. If you blunt only the beta effects, the alpha effects remain unopposed, which can raise blood pressure, worsen chest pain or ischemia, and precipitate adverse cardiovascular events. The safer approach is to use benzodiazepines to calm CNS-driven sympathetic activation, with supportive care and, if needed, antipsychotics for severe agitation.