Enalapril to combat cardiac effects from stimulants...

Discussion in 'Pharmacology' started by Nicaine, Dec 3, 2006.

  1. Nicaine

    Nicaine Titanium Member

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    I have something of a mini pharmacy lying around, in terms of having been prescribed some rather unusual substances (often after just outright asking a doctor) or picking them up from other sources.

    Recently SWIM acquired some enalapril, which is a drug sometimes prescribed for high blood pressure, but more often for certain types of heart failure. It's in a class of drugs known as ACE inhibitors, and its primary mode of action is vasodilation... in other words, it dilates or expands blood vessels. This lowers blood pressure and eases the work load on the heart.

    I was recently warned against enalapril by someone (sorry, forgot who). He's got other substances around (beta blockers, calcium channel blockers) so at first he didn't give it a second thought, but recently he read about a controversy involving calcium channel blockers (verapamil, diltiazem, nifedipine, etc). Apparently they may not decrease cardiac mortality at all, and in some cases could actually increase it.

    Most beta blockers are not great substances to take with stimulants either (blood pressure can shoot up) so I started researching enalapril again, and it turns out to be one of the safest and most well tolerated cardiac drugs on the market * * *. It seems most people get few or no side effects from it. He's tried lower doses of it a couple times at this point, and it definitely seems to be helpful with stimulants that cause vasoconstriction and increased blood pressure (that's most of them... cocaine, amphetamines, propylhexedrine, etc). Less palpitations, slower heart rate, warmer hands and feet. It also increases blood flow to the muscles and kidneys, which could be a major benefit with some stimulants.

    If anyone else has tried it, I would be interested to hear what they think. Harm reduction is cool... spread it around.

    P.S. probably the best document I've found covering the effects of enalapril and (indirectly) supporting its use as a harm reduction measure is here. A few selected quotes (all rolled into one):
     
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  2. fingerbib

    fingerbib Newbie

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    This is my first post so hi, but I have been an observer for a while...

    Nicaine, I believe it is you who responded to a certain post I made on another forum, concerning ACE-inhibitors, beta-blockers, and propylhexedrine. I'm interested in theoretical ways to lessen the body loads of stimulants and figured I would share some info here

    I took 250mgs of propylhexedrine (cotton in gelcaps) with a starting BP of 125/71. That is slightly higher then normal for this individual. At about 3 hours in was the highest point of swims BP, 174/101. I took 4mgs of the ACE inhibitor perindopril. An hour later, swim's BP was at 157/87. The decline in BP could have been due to propylhexedrine being metabolized, but swims BP stayed generally around 157/87 for an hour or so (he stopped taking readings), leading swim to believe the decrease was cause by 157/87, which I suppose should not be a shock.

    Some interesting things I've come across...
    It seems perindopril increased striatal dopamine dialysate levels, but "Levels of dopamine D1 and D2 receptors and of preprotachykinin and tyrosine hydroxylase mRNAs" were not affected. This was seen after chronic administration, but I still wonder what possible implications it could carry. source
    There are also a lot of articles perindopril's ability to prevent some of the damage of the dopamine neurotoxin MPTP. I believe I might have read about protection from (meth)amphetamine induced damage, but I can't find a source right now, and my memory could very well be faulty
    The ACE-inhibitor fosinopril is being researched as a treatment for cocaine addiction. I wonder if it is because it diminishes the effects making it less reinforcing, increases natural dopamine so addicts aren't trying to self-medicate, or both, or neither. source
    It seems ACE inhibitors may be useful for more then just lowering bloodpressure in regards to stimulants.
     
  3. Nicaine

    Nicaine Titanium Member

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    Could be; fwiw, I find that enalapril decreases the subjective 'positive' effects of dopaminergic stimulants very little, while noticeably decreasing negative sides such as headaches, arrhythmias and numbless/tingling/coldness of extremities. Works especially well with subbies that have a lot of unwanted peripheral effects, such as propylhexedrine.
     
  4. snapper

    snapper Gold Member

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    I am not a doctor, but is the one who warned caution with ACE inhibitors. Though they are benign to most, they are not to all and some I have known have found this class of drugs intolerable. SWINicaine's arguements are good, but there can be more problems with this than with something like atenolol. It would be nice if it helps, CE inhibitors are the #1 prescribed blood pressure med in the US. More side effects are seen with long term once or twice daily use than with intermittent use like SWINicaine suggests. Also, lisinopril is a newer version of the drug which is better tolerated and usually the one first given out by MDs for hypertension. Enalapril is shorter acting as well, which may be better for SWINicaine's applications.
     
  5. event

    event Newbie

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  6. snapper

    snapper Gold Member

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    I think that if one is to use hypotensives and antiarrythmics as harm reduction, best to go to yous MD and say that You has high blood pressure. Experimenting with these drugs to diminish the harmful effects of drugs is a bad idea.
    Verapamil is a calcium channel inhibitor, which drops hr/bp.
    Enalapril is an ace inhibitor, which drops blood pressure and has other beneficial effects on cardiac function. The latter takes many days to show any beneficial effects, so is useless for on the spot harm reduction.

    Probably the most useful harm reduction drugs are beta blockers and benzos. Beta blockers drop BP and HR fast, which with stims and hallucinogenics, are the most likely problems. Verapamil would not address the problem as quickly or directly.

    That said, if you need these drugs with your recreational ones, you should probably lower the dosage and frequency of use. If blood pressure drugs are necessary, best to consult with a doctor first - SWIM doubts that most would balk at helping You control high bps, anxiety or other symptoms..