Metoprolol Intoxication

Sire, S

doi:10.1016/s0140-6736(76)91115-6

Cited by 15 publications

(2 citation statements)

References 4 publications

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“…Following metoprolol overdosage (Moller 1976;Sire 1976), normal sinus rhythm is usually maintained despite hypotension, as in a case reported by Shore et al (1981) with a plasma concentration of 63 mg/L, Profound bradycardia has been reported in the near terminal stages of metoprolol poisoning (Shore et al 1981;Wallin & Hulting 1983), but then it was probably due to secondary factors such as hypoxia and acidosis. However, metoprolol does have a small degree of membrane depressant activity which may contribute to toxicity.…”

Section: Sotalolmentioning

confidence: 93%

The Management of Acute Poisoning Due to β-Adrenoceptor Antagonists

Julian

Ungar

1989

Medical Toxicology

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Although many cases of beta-adrenoceptor antagonist (beta-blocker) poisoning are uneventful, a proportion develop serious and sometimes fatal cardiovascular system depression with severe hypotension. As beta-adrenergic tone is not essential for cardiovascular function in health, there is no physiological reason why total beta-adrenoceptor blockade should have serious consequences in the resting individual. The toxic actions of beta-blockers appear to be related to properties such as membrane depressant activity and possibly due to actions on beta-adrenoceptors distinct from those in the cardiovascular system. Most reports of serious adverse effects following overdosage concern beta-blockers with significant membrane depressant activity, and in particular propranolol and oxprenolol, with which progressive heart block and bradycardia are features. Sotalol toxicity, with its unique electrophysiological action, is a special case. Animal experiments confirm that beta-blockers with membrane depressant activity are more toxic than the newer more selective ones, such as atenolol and nadolol. However, experimental models also reveal that artificial ventilation markedly reduces the toxicity of all beta-blockers tested, suggesting a respiratory depressant action with very high doses. Treatment of serious overdosage in man should include maintenance of adequate ventilation. High dose intravenous glucagon is recommended, because its inotropic action depends on direct stimulation of adenylate cyclase. beta-Agonists such as isoprenaline (isoproterenol) or prenalterol may be effective, but the nature of agonist-competitive antagonist interactions may necessitate the use of unrealistically large doses to overcome very high tissue beta-blocker concentrations.

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Section: Sotalolmentioning

confidence: 93%

The Management of Acute Poisoning Due to β-Adrenoceptor Antagonists

Julian

Ungar

1989

Medical Toxicology

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“…Few acute intoxications with beta-blocking agents have been described despite of their common use. Massive doses of propranolol, practolol and metoprolol have been ingested with relatively mild effects (Boakes & Boeree 1973;Wermut & Wbjcicki 1973;Karhunen & Hartel 1973;Moller 1976;Sire 1976). On the other hand, severe circulatory collapse, asystole and even deaths have been described due to propranolol, oxprenolol and alprenolol (Lagerfelt & Matell 1976;Frithz 1976;Khan & Muscat-Baron 1977;Alha et a/.…”

mentioning

confidence: 99%

Sotalol Intoxication, Two Patients with Concentration ‐ Effect Relationships

Neuvonen

Elonen

Tarssanen

1979

Acta Pharmacologica et Toxicologica

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Two adult patients ingested an overdose of 2.4 g and 8.0 g of sotalol hydrochloride, respectively, i.e. 7-25 times the mean daily dose. Certain signs as bradycardia and hypotension were similar to those described for other beta-blocking agents. In addition to these, however, both patients had severe cardiac tachyarrhythmias and a considerably prolonged QT-interval in their electrocardiogram. The decline of serum sotalol concentrations followed first-order kinetics with the elimination half-life of 13-1 5 hours. There was a good correlation between the serum sotalol concentration and the prolongation of the QT-interval. Sotalol differs from other beta-blocking agents in its effects on the action potential of the ventricular muscle and Purkinje fibers of the heart. This is likely to explain the different symptoms and findings of sotalol intoxication compared to those seen in connection with other beta-blocking agents.

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Diagnosis and Treatment of Drug Overdose

McCarron¹

1986

Topics in Clinical Pharmacology and Therapeutics

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Metoprolol Intoxication

Cited by 15 publications

References 4 publications

The Management of Acute Poisoning Due to β-Adrenoceptor Antagonists

The Management of Acute Poisoning Due to β-Adrenoceptor Antagonists

Sotalol Intoxication, Two Patients with Concentration ‐ Effect Relationships

Diagnosis and Treatment of Drug Overdose

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