Best evidence topic report. Cocaine induced myocardial ischaemia: nitrates versus benzodiazepines.

A short cut review was carried out to establish whether nitrates are better than benzodiazepines in the treatment of cocaine induced chest pain. Seven citations were reviewed of which two answered the three part question. The clinical bottom line is that in patients with cocaine induced chest pain it appears that nitrates or benzodiazepines are effective in combination or alone in resolving chest pain and improving cardiac performance. We recommend that the agent of choice may be influenced by the presence or absence of concurrent CNS symptoms.