Drug interactions
Cocaine + Propranolol
Severity: Major
Cocaine and Propranolol: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
With systemic cocaine, nonselective beta-blockade leaves alpha-adrenergic vasoconstriction unopposed, which can cause hypertension, coronary vasospasm and angina. With topical clinical use, systemic exposure is small and the risk is lower but not nil.
What this interaction means in plain words
Cocaine and Propranolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Cocaine belongs to Central Nervous System; Propranolol belongs to Cardiovascular.
Why it happens
Blockade of beta-2 vasodilation leaves cocaine-induced alpha-mediated vasoconstriction unopposed.
What to do
Avoid propranolol and other nonselective beta-blockers in acute cocaine toxicity. For topical cocaine, use the lowest dose and monitor blood pressure and chest pain.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Cocaine and Propranolol, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
Other interactions of Propranolol
- Propranolol + Thioridazine Contraindicated
- Acebutolol + Propranolol Major
- Adrenaline-articaine + Propranolol Major
- Amifostine + Propranolol Major
- Amiodarone + Propranolol Major
- Arformoterol + Propranolol Major
Other interactions of Cocaine
- Cocaine + Isocarboxazid Contraindicated
- Cocaine + Phenelzine Contraindicated
- Cocaine + Procarbazine Contraindicated
- Amitriptyline + Cocaine Major
- Bisoprolol + Cocaine Major
- Citalopram + Cocaine Major
Frequently asked questions
Can I take Cocaine with Propranolol?
MediHelp rates the interaction as major. Cocaine and Propranolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. With systemic cocaine, nonselective beta-blockade leaves alpha-adrenergic vasoconstriction unopposed, which can cause hypertension, coronary vasospasm and angina. With topical clinical use, systemic exposure is small and the risk is lower but not nil.
How serious is the interaction between Cocaine and Propranolol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid propranolol and other nonselective beta-blockers in acute cocaine toxicity. For topical cocaine, use the lowest dose and monitor blood pressure and chest pain.
What other medicines interact with Propranolol?
MediHelp also lists interactions of Propranolol with, for example, Thioridazine, Acebutolol, Adrenaline-articaine. The full list is on the Propranolol page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
