Calcium and Beta Receptor Antagonist Overdose: A Review and Update of Pharmacological Principles and Management

Abstract

Calcium channel and beta-adrenergic receptor antagonists are common pharmaceutical agents with multiple overlapping clinical indications. When used appropriately, these agents are safe and efficacious. In overdose, however, these agents have the potential for serious morbidity. Calcium channel blockers and beta blockers share similar physiological effects on the cardiovascular system, such as hypotension and bradycardia, in overdose and occasionally at therapeutic doses. The initial management for symptomatic overdose of both drug classes consists of supportive care measures. Other therapies including administration of glucagon, calcium, catecholamines, phosphodiesterase inhibitors and insulin have been used with varying degrees of success. In addition, intra-aortic balloon pump and extracorporeal membrane oxygenation techniques have been successfully utilized in refractory cases. This article reviews beta blocker and calcium channel blocker pharmacological principles and updates current management strategies.

Toxicology in the Critical Care Unit

“…Severe CCB toxicity unresponsive to therapies mentioned above may require cardiac pacing and other advanced therapies such as intra-aortic balloon pump or extracorporeal membrane oxygenation. 61 ␤-Blocker toxicity is still most commonly treated by administering high-dose glucagon therapy. A glucagon bolus of 5 to 10 mg (150 g/kg) over 1 to 2 min is frequently used in this setting.…”

Intrapleural and Intraperitoneal Free Fluid in Calcium Channel Blocker Overdose

“…However, in patients with severe hypotension, IV calcium, glucagon, inotropic therapy, high-dose insulin therapy, lipid emulsion, and aortic balloon pump application are other treatments (10,13,14). In our study, IV calcium, hydration with normal saline, and inotropic therapy were administered to the patients with hypotension and with USG-detected peritoneal and pleural free fluid.…”

“…The presence of variable amounts of collaterals makes the colon susceptible to ischemia (15). Depending on the CCB overdose, although complicated and surgery-requiring complications such as submucosal edema, ischemia, necrotic ulceration, bleeding, and even gangrene have been observed in case reports in the literature, clinical situations, such as pseudo-obstruction, that can be treated without surgical treatments have also been shown (2,10). In a patient who developed non-occlusive colonic ischemia due to verapamil overdose, Perbet et al (5) found a gangrenous segment in the left column with exploratory laparotomy, and a histopathological examination revealed submucosal edema, necrotic patchy ulceration areas, and intramural hemorrhage due to submucosal vessel dilatation.…”

A very rare side effect of amlodipine: non-cardiogenic pulmonary edema

“…In addition to intravenous fluids, if necessary, inotropic drugs should be used for hypotension. [1][2][3][4][5][6]9] In certain cases, calcium infusions may improve contractility and hypotension. [10] In our case, we used activated charcoal for intestinal lavage, intravenous fluid, positive inotropic drugs, and intravenous calcium infusion.…”