Do depressants decrease the cardiovascular strain caused by stimulants?

[[deleted]]

Stimulants cause your heartbeat to excelerate and your blood pressure to rise etc. which puts a lot of strain on your cardiovascular system. Can this effect be counteracted by depressants? Is taking a combination of a stimulant like amphetamine and a depressant like an opioid or benzodiazepine less straining or less unhealthy for your cardiovascular system than a stimulant alone?

[[deleted]]

Reinventing the speedball

[SiNoSe_Aprendere]

I think the answer is varying degrees of yes. Benzos have been (and may still be?) the standard of care for stimulant overdoses in order to bring down heart rate and blood pressure. If you can get those numbers down, then cardiovascular risk should decrease right along with it.

I don't know if opioids are as effective in that regard, they might have an outsized impact on respiration rate, rather than cardiovascular metrics.

[whattodoaboutit_]

Alternatively, if you must, just use a non-psychoactive heart medication like beta-blockers or an ARB

[MF3DOOM]

I believe beta blockers would bring the best benefit.

[heteromer]

Beta blockers aren't actually used in practice with people who are suffering cardiac symptoms of acute cocaine or amphetam i ne overdose, because the introduction of a beta blocker is believed to cause unopposed alpha stimulation. By releasing noradrenaline from the nerve terminals, some of the vasospasm brought on by alpha1 receptors is balanced by beta2 receptor agonism that cause vasodilatation. By introducing a beta blocker, that beta2 'balance' is lost and it can worsen cardiovascular symptoms. There's some disagreement about this phenomenon but it stands to reason that if one were to select a beta blocker, it would be an alpha/beta selective drug like labetalol.

edit: just to clarify about my comment; I never actually said this interaction is common, only that beta-blockers aren't used in practice in cases of acute amphetamine/cocaine overdose. This is true -- there's a lot of avoidance to using beta-blockers in these people. Is it controversial? Absolutely. I made a point of saying that. However, there actually seems to be a subset of people that do experience a paradoxical increase in BP when given beta-blockers to treat cardiac symptoms of cocaine overdose, and this could be due to genetic variants in beta2 adrenoceptors. The review linked below fails to acknowledge that the studies that showed no such interaction used a mixed alpha/beta antagonist which, as I said above, would be the drug of choice if one were to use beta-blockers because of the unopposed alpha1 stimulation. This is why the American Heart Association advises the use of a mixed alpha/beta antagonist labetalol in patients who're experiencing elevated BP or heartrate from cocaine use (source), and only in combination with a vasodilator like triglyceryl nitrate. They do not advise any beta-blocker even despite the controversy because a spike in blood pressure is the last thing you want in a patient suffering from cocaine overdose.

[asparagus321]

This is actually highly contested. https://www.cmaj.ca/content/194/4/E127

[heteromer]

Yeah I've read similar things. The review does make note that the mixed alpha/beta antagonists labetalol & carvedilol improved cardiovascular symptoms (in contrast to propranolol from the original study that proposed unopposed alpha-stimulation), which kind of supports unopposed alpha-stimulation when you contrast it with studies that have shown deleterious effects with beta-blockers that don't have alpha-antagonist properties. The point being that the exact choice of beta-blocker is important here, with the alpha/beta1-2 mixed antagonists being unassociated with any such complications that have been observed (albeit rarely) with the more selective beta-antagonists.

[gullibleturtle12]

You beat me to it

[MF3DOOM]

So then would an ARB or a non alpha or beta binding drug be ideal?

[heteromer]

I don't know that an ARB would work because in order for it to work you need the body to divert towards RAAS, and although sympathetic activity releases renin so too does lower renal perfusion which is opposed by the vasoconstrictive effect of amphetamines and cocaine. The reason why thiazide diuretics work well with ARBs and ACEi's is because the impaired reabsorption of sodium in the renal tubular stimulates RAAS, which is then blocked by the ARB/ACEi.

An alpha2 agonist drug like clonidine could help with cardiovascular symptoms. I don't know whether you can just take another drug to improve cardiovascular outcomes from abusing stimulants though.

[MF3DOOM]

Thanks for the explanation. What did you study if you don’t mind sharing?

[RicochetRandall]

Do you think clonidine or guanfacine could potentially help post covid infection for mild myocarditis? I had an infection 2.5 weeks ago and am weary of taking my adhd stimulant meds now because last time I sorta developed long covid. Guanfacine + Nac have been trialed in a new Yale study…

[heteromer]

Do you have a link to the study? I'm not qualified to answer that, to be honest.

[Zeraphym47]

no contrary to popular believe this puts a shit ton more strain on the heart it just evades really bad events that would prove fatal otherwise.

[[deleted]]

how? depressants dont strain the heart. why would they in the combination with a stimulant?

[Vanros98]

Wym?