Tarka® (Trandolapril/Verapamil Hydrochloride Extended-Release) overdose

Cohen, Victor; Jellinek, Samantha P.; Fancher, Lydia; Sangwan, G; Wakslak, Menachem; Marquart, Elizabeth; Farahani, Cyrus

doi:10.1016/j.jemermed.2008.10.015

Cited by 15 publications

(14 citation statements)

References 20 publications

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“…[553][554][555][556][557][558][559][560][561][562][563][564][565][566][567][568] Treatment Recommendation There is insufficient clinical evidence to suggest any change to cardiac arrest resuscitation treatment algorithms for patients with cardiac arrest caused by calcium channel blockers. Case reports suggest severe cardiovascular toxicity caused by calcium channel blockers may respond to treatment with high-dose insulin given with glucose supplementation and electrolyte monitoring in addition to conventional treatment.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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“…However in cases with sustained-release verapamil toxicity symptoms appear 12 hours after drug intake and they may persist for 48-72 hours (9,10) . In verapamil toxicity myocardial toxicity or the development of heart failure related to complete heart block are responsible for mortalities (11) . The symptoms of this case started 12 hours after intake of 6 Tarka tablets, each tablet containing 180 mg verapamil and 2 mg trandolapril and the first adverse symptom was fatigue.…”

Section: Discussionmentioning

confidence: 99%

“…Minimal toxic dose of verapamil has not been established clearly. Both in fetal and non-fetal cases doses of 800 mg and 24000 mg values have been indicated (11,12) . The average non-toxic dose of verapamil is 320 mg and its average toxic dose is 3.2 g (13) .…”

Section: Discussionmentioning

confidence: 99%

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Severe Cardiac and Renal Findings in an Adolescent Girl: Trandolapril/Verapamil Hydrochloride Overdose

Alaygut¹,

Orbatu²,

Oflaz³

2019

TERH

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Trandolapril/verapamil hydrochloride combination is an antihypertensive drug. A 15-year-old female patient was brought to our hospital with the findings of fatigue and somnolence. It was learnt that 12 hours before her admittance, she had taken tablets each containing 180 mg verapamil and 2 ml trandolapril. Temporary pacemaker was implanted to the patient for monitorization who had clinical picture of bradycardia, hypotension and acute renal failure and appropriate fluid treatment was administered. Pacemaker was removed after 12 hours because normal heart rhythm was restored. Acute renal failure was resolved with fluid replacement. This case was reported in order to present findings of cardiac and renal toxicity which may develop due to the use of fixed-dose combination drugs such as trandolapril/verapamil hydrochloride that are rarely prescribed in childhood and adolescent age group.

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“…25 Naloxone may also be effective in reversing the hypotensive effects of ACE-I. 14 Recently, on the basis of the lipophilic properties of verapamil, findings in a rat model of verapamil poisoning suggest that therapy with the lipid emulsion intralipid may provide a survival benefit. 27 The use of insulin to treat CCB intoxication is another choice in the treatment of severe CCB poisoning.…”

Section: Discussionmentioning

confidence: 99%

Tarka® overdose in a young child

et al. 2010

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Tarka® is a combination antihypertensive medication composed of verapamil hydrochloride and trandolapril. A 3.5-year-old female was brought to our hospital due to a sleepy condition 7 hours after an accidental ingestion of six tablets of Tarka® containing 240 mg verapamil hydrochloride and 4 mg trandolapril in each tablet. Five hours after hospitalization, her condition deteriorated and arterial pressure progressively decreased despite the treatment. Finally, a temporary pacemaker was implanted, after which the vital findings began to return to normal values. The pacemaker was removed 13 hours after implantation as normal heart rhythm was observed. There are no reports of intoxication with fixed-dose combination products, especially Tarka®, in young children in the literature. Therefore, we believe that our report can provide an insight on the toxic dose of this drug in younger children. Clinicians should keep in mind that lethargy can be the first symptom of a possible clinical deterioration, even in normotensive and normorhythmic individuals.

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Tarka® (Trandolapril/Verapamil Hydrochloride Extended-Release) overdose

Cited by 15 publications

References 20 publications

Part 8: Advanced Life Support

Part 8: Advanced Life Support

Severe Cardiac and Renal Findings in an Adolescent Girl: Trandolapril/Verapamil Hydrochloride Overdose

Tarka® overdose in a young child

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