Treatment of poisoning caused by β-adrenergic and calcium-channel blockers

Shepherd, Greene

doi:10.2146/ajhp060041

Cited by 97 publications

(86 citation statements)

References 28 publications

(44 reference statements)

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“…Whole-bowel irrigation may be considered in patients with delayed presentations. 54 The dihidropyridine class of CCBs (eg, amlodipine and nimodipine) usually leads to significant hypotension without bradycardia, whereas the nondihidropyridine class of CCBs (eg, diltiazem and verapamil) leads most commonly to bradycardia and, in the most severe overdoses, cardiogenic shock and sinus arrest. Therapies for CCB overdose usually require volume resuscitation and vasopressors to maintain BP and heart rate.…”

Section: Cardiovascular Medicationsmentioning

confidence: 99%

Toxicology in the Critical Care Unit

Alapat

Zimmerman

2008

Chest

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Section: Cardiovascular Medicationsmentioning

confidence: 99%

Toxicology in the Critical Care Unit

Alapat

Zimmerman

2008

Chest

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“…Traditionally, BB toxicity was treated with glucagon and CCB with calcium gluconate infusion. 8 However, glucagon was not available in our institution and our patient was maintaining vitals on high dose of inotropic support. …”

Section: Discussionmentioning

confidence: 87%

A Case of suspected Sick Sinus Syndrome due to combined Beta-blocker and Calcium Channel Blocker Therapy: Anesthesia Management

Gala¹,

Dalvi²,

Mahajan³

et al. 2017

Journal of Research &Amp; Innovation in Anesthesia

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Sick sinus syndrome (SSS) is a generalized abnormality of cardiac impulse formation. Abnormalities encompassed by this syndrome may include inappropriate sinus bradycardia, sinus arrest, bradyarrhythmias, or tachyarrhythmias. We present a case of a 54-year-old hypertensive male posted for L4-L5 decompression, whom we suspected to develop SSS due to overdose of combined beta-blocker (BB) and calcium channel blocker (CCB) therapy.

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“…However, unfortunately, there are no strongly recommended first‐line treatments for refractory patients and the level of evidence was very low 2. Therefore, a multimodal therapeutic approach is often used according to the situation 3, 4, 5…”

Section: Discussionmentioning

confidence: 99%

“…The use of calcium to treat CCB poisoning is physiologically reasonable and clinically indicated, but the response to calcium is also inadequate 3, 4, 5. A systematic review4 reported that adverse effects of therapeutic calcium infusion are rare following CCB poisoning.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of isoproterenol for treating amlodipine overdose resulting in bradycardia

Ebihara

Morita

Kawada

et al. 2017

Acute Medicine & Surgery

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CaseAmlodipine predominantly affects vascular smooth muscle cells. Amlodipine overdose usually presents with vasodilatory shock, accompanied by reflex tachycardia rather than bradycardia.An 81‐year‐old woman presented with impaired consciousness 8 h after ingesting 50 5‐mg amlodipine tablets with suicidal intent. On admission, her blood pressure was 50/40 mmHg and her heart rate was 45 b.p.m. Serum amlodipine level was extremely high (474.4 ng/mL), causing refractory bradycardia. She remained hypotensive despite fluid resuscitation, and therefore was administered dopamine and norepinephrine. She was also administered glucagon and calcium gluconate, and underwent high‐dose insulin euglycemic therapy.OutcomeAlthough her blood pressure improved, bradycardia progressively worsened and isoproterenol infusion was initiated, which resulted in an improvement in her heart rate. The patient discharged on day 14 without any complications.ConclusionIsoproterenol is effective for treating bradycardia after amlodipine overdose.

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Treatment of poisoning caused by β-adrenergic and calcium-channel blockers

Cited by 97 publications

References 28 publications

Toxicology in the Critical Care Unit

Toxicology in the Critical Care Unit

A Case of suspected Sick Sinus Syndrome due to combined Beta-blocker and Calcium Channel Blocker Therapy: Anesthesia Management

Efficacy of isoproterenol for treating amlodipine overdose resulting in bradycardia

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