Avoidance of β-blockers in patients who use stimulants is not supported by good evidence

摘要

Physicians often hesitate to prescribe β-blocker therapy for patients who actively use stimulants, even for indications such as heart failure with reduced ejection fraction and tachyarrhythmias, worrying that potentially harmful interactions will outweigh well-established benefits. The American Heart Association guidelines for the management of non-ST elevation myocardial infarction (NSTEMI), published in 2014, advise against using β-blockers in acute myocardial infarction with signs of acute stimulant intoxication, unless patients are also receiving a coronary vasodilator. Outside of acute stimulant intoxication, however, these guidelines state that patients presenting with NSTEMI and recent stimulant use should receive the same care as patients who do not use stimulants. A Canadian guideline on heart failure makes no specific recommendations for or against the use of β-blockers in patients who use stimulants. We argue that in the absence of guidance to the contrary, doctors should reconsider their tendency to withhold β-blockers from patients who use stimulants.