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ASSESSMENT & COMPLICATIONS

Hypertension may be due to poisoning with amphetamines and synthetic stimulants, anticholinergics, cocaine, performance-enhancing products (containing caffeine, phenylephrine, ephedrine, or yohimbine), monoamine oxidase (MAO) inhibitors, and other drugs.

Severe hypertension (eg, diastolic blood pressure greater than 105–110 mm Hg in a person who does not have chronic hypertension) can result in acute intracranial hemorrhage, myocardial infarction, or aortic dissection.

TREATMENT

Treat hypertension if the patient is symptomatic or if the diastolic pressure is higher than 105–110 mm Hg—especially if there is no prior history of hypertension.

Hypertensive patients who are agitated or anxious may benefit from a sedative (such as lorazepam, 2–3 mg intravenously) or an antipsychotic drug (eg, haloperidol or olanzapine). For persistent hypertension, administer phentolamine, 2–5 mg intravenously, or nitroprusside sodium, 0.25–8 mcg/kg/min intravenously. If excessive tachycardia is present, add esmolol, 25–100 mcg/kg/min intravenously, or labetalol, 0.2–0.3 mg/kg intravenously. Caution: Do not give beta-blockers alone, since doing so may paradoxically worsen hypertension in some cases as a result of unopposed alpha-adrenergic stimulation.

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Le Roux  G  et al. Recreational phenethylamine poisonings reported to a French poison control center. Drug Alcohol Depend. 2015 Sep 1;154:46–53.
[PubMed: 26205314]
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Richards  JR  et al. Treatment of toxicity from amphetamines, related derivatives, and analogues: a systematic clinical review. Drug Alcohol Depend. 2015 May 1;150:1–13.
[PubMed: 25724076]

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