Management of calcium channel blocker overdoses

Abstract

Calcium channel blockers (CCBs) are some of the most commonly used medications in clinical practice to treat hypertension, angina, cardiac arrhythmias, and some cases of heart failure. Recent data show that CCBs are the most common of the cardiovascular medications noted in intentional or unintentional overdoses.1 Novel treatment approaches in the form of glucagon, high‐dose insulin therapy, and intravenous lipid emulsion therapies have been tried and have been successful. However, the evidence for these are limited to case reports and case series. We take this opportunity to review the various treatment options in the management of CCB overdoses with a special focus on high‐dose insulin therapy as the emerging choice for initial therapy in severe overdoses. Journal of Hospital Medicine 2014;9:663–668. © 2014 Society of Hospital Medicine

Scientific research related to calcium channel blockers poisoning

“…The total number of citations at the time of data analysis (23 October 2014) was 6462, with an average of 9.1 citations per document and a median (interquartile range) of 3(0.0-10.5). The highest median (interquartile range) number of citations was 8 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) for the United States, followed by 6 (1-21) for Australia, 5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) for the United Kingdom, and 5 for Canada. The h-index of the retrieved documents was 37 (i.e.…”

“…1,2 Moreover, of cardiovascular medications, CCBs were the most common agents associated with a significant morbidity and mortality rate. 2,3 CCBs were responsible for at least 78 deaths in 2011 in the United States. 4 CCBs poisoning is on the rise, 4,5 and it has resulted in growing research in many research areas such as emergency medicine 6,7 or cardiovascular 8,9 or clinical toxicology.…”

“…Calcium channel blockers (CCBs) are some of the most commonly used medications in clinical practice to treat hypertension, migraine headaches, angina pectoris, Raynaud phenomenon, and cardiac arrhythmias. 1,2 Moreover, of cardiovascular medications, CCBs were the most common agents associated with a significant morbidity and mortality rate. 2,3 CCBs were responsible for at least 78 deaths in 2011 in the United States.…”

“…1,2 Moreover, of cardiovascular medications, CCBs were the most common agents associated with a significant morbidity and mortality rate. 2,3 CCBs were responsible for at least 78 deaths in 2011 in the United States. 4…”

Management of Calcium Channel Blocker Toxicity in the Pediatric Patient

“…5,12,[26][27][28][29][30][31][32][33] Although there is no consensus regarding duration of high-dose insulin therapy, many clinicians continue administration until hemodynamic stability is achieved. 36 Potential adverse effects of high-dose insulin include hypoglycemia and hypokalemia. 36 In the documented pediatric case reports using high-dose insulin, only Yuan et al 26 reported hypoglycemia during the highdose insulin infusion, but this event was asymptomatic and easily corrected with a dextrose bolus.…”