Calcium Channel Blocker Toxicology

Hedge, Matthew

doi:10.1177/0897190005276749

Cited by 2 publications

(5 citation statements)

References 35 publications

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“…Systemic calcium administration has demonstrated positive inotropic and increased blood pressure effects. 2,7,8…”

Section: Discussionmentioning

confidence: 99%

“…Norepinephrine has potent vasoconstrictive effects through agonism of the alpha-1 receptor and positive inotropic effects through agonism of the beta-1 receptor and is the recommended first-line vasopressor. 2,9 The patient described in this case required 3 vasopressor agents to maintain adequate tissue perfusion (goal MAP of 65 mm Hg). Vasopressin is not a preferred agent, because it may exacerbate negative inotropic effects seen in CCB toxicity.…”

Section: General Managementmentioning

confidence: 99%

“…Systemic calcium administration has demonstrated positive inotropic and increased blood pressure effects. 2,7,8 Given the underlying pathophysiology of severe peripheral vasodilation, vasopressors may be required to maintain systemic perfusion. Norepinephrine has potent vasoconstrictive effects through agonism of the alpha-1 receptor and positive inotropic effects through agonism of the beta-1 receptor and is the recommended first-line vasopressor.…”

Section: General Managementmentioning

confidence: 99%

“…3 Non-dihydropyridine CCBs (diltiazem and verapamil) work in the cardiac nodal tissue to slow conduction and demonstrate negative chronotropic, dromotropic, and inotropic *Pharmacology Fellow, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York; effects. 3 However, at toxic levels this difference in site of effect between classes is less pronounced, 2,5 thus all dihydropyridine and non-dihydropyridine CCBs may cause hypotension, bradycardia, heart block, and shock.…”

mentioning

confidence: 99%

“…All CCBs act through blockade of voltage gated L-type calcium channels. [2][3][4] At therapeutic doses, dihydropyridine CCBs (amlodipine, nifedipine, felodipine, nimodipine, and nicardipine) act by relaxation of smooth muscle surrounding blood vessels in the periphery and heart. 3 Non-dihydropyridine CCBs (diltiazem and verapamil) work in the cardiac nodal tissue to slow conduction and demonstrate negative chronotropic, dromotropic, and inotropic *Pharmacology Fellow, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York; effects.…”

mentioning

confidence: 99%

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Intravenous Lipid Emulsion in the Management of Amlodipine Overdose

et al. 2013

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Objective: To report a case of amlodipine overdose successfully treated with intravenous lipid emulsion (ILE). Case Summary: A 47-year-old, 110 kg female ingested at least 350 mg of amlodipine with an unknown amount of ethanol. Initial blood pressure was 103/57 mm Hg, mean arterial pressure (MAP) 72 mm Hg, and heart rate 113 beats per minute. In the early clinical course, activated charcoal, intravenous fluid, and calcium boluses were administered. Worsening hypotension prompted a 100 mL bolus of 20% ILE. Stable hemodynamics were maintained for 2 hours. Subsequently, profound hypotension and shock developed (MAP 38 mm Hg), which failed to fully respond to 3 vasopressor agents, calcium, and glucagon. With continuing shock despite optimized vasopressors, an infusion of 2,300 mL 20% ILE was administered over 4.5 hours (20.9 mL/kg infusion total). By completion of the infusion, 2 vasopressors were tapered off and MAP remained above 70 mm Hg; within 12 hours, no further interventions were required. Possible adverse events of ILE, lipemia and hypoxia, were experienced but quickly resolved. The patient survived to hospital discharge within 8 days. Discussion: Toxicity of amlodipine presents similar to distributive shock as both are due to marked peripheral vasodilation. There are numerous interventions in the management of amlodipine overdose, despite which many patients continue to suffer life-threatening shock as observed with this patient. ILE has been used with promising preliminary results as salvage therapy in case reports of other lipophilic molecules. This is the first report of lone amlodipine overdose treated with ILE. Conclusion: ILE is a novel antidote for overdoses of lipophilic substances and demonstrated efficacy in this case of amlodipine overdose without the use of hyperinsulinemic euglycemia.

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“…Systemic calcium administration has demonstrated positive inotropic and increased blood pressure effects. 2,7,8…”

Section: Discussionmentioning

confidence: 99%

Section: General Managementmentioning

confidence: 99%

Section: General Managementmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Intravenous Lipid Emulsion in the Management of Amlodipine Overdose

et al. 2013

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A Case of Fatal Felodipine Overdose

Lota

Powell²,

Negus³

et al. 2008

Acute Med

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A 54 year gentleman was admitted to hospital within four hours of taking an overdose of modified release felodipine tablets, with a total dose of approximately 250 mg. The initial management comprised fluid resuscitation, calcium chloride and glucagon. He remained hypotensive and was commenced on hyperinsulinaemia-euglycaemic therapy. Hypotension persisted with the development of progressive metabolic acidosis despite increasing inotropic support, haemofiltration and high dose insulin-dextrose infusions. The patient died 60 hours post overdose. The case highlights the profound, refractory circulatory collapse and lethal consequences of significant calcium channel blocker overdose and also reviews potential management strategies to attempt to reverse these changes. Despite the lack of evidence of whole bowel irrigation in overdose per se, its role in the removal of modified release compounds has not been studied. We would strongly urge emergency departments to consider this therapeutic modality, especially in overdoses involving delayed release preparations of calcium channel blockers, which are extremely toxic in overdose and are associated with very high mortality.

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Calcium Channel Blocker Toxicology

Cited by 2 publications

References 35 publications

Intravenous Lipid Emulsion in the Management of Amlodipine Overdose

Intravenous Lipid Emulsion in the Management of Amlodipine Overdose

A Case of Fatal Felodipine Overdose

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