Paper
Treatment of poisoning caused by β-adrenergic and calcium-channel blockers
Published Oct 1, 2006 · G. Shepherd
American Journal of Health-system Pharmacy
88
Citations
4
Influential Citations
Abstract
Purpose. The toxic effects and treatment of β-adrenergic blocker and calcium-channel blocker (CCB) overdose are reviewed. Summary. Overdoses with cardiovascular drugs are associated with significant morbidity and mortality. Beta-blockers and CCBs represent the most important classes of cardiovascular drugs. In overdose, β-blockers and CCBs have similar presentation and treatment overlaps and are often refractory to standard resuscitation measures. The common feature of β-blocker toxicity is excessive blockade of the β-receptors resulting in bradycardia and hypotension. Poisoning by CCBs is characterized by cardiovascular toxicity with hypotension and conduction disturbances, including sinus bradycardia and varying degrees of atrioventricular block. Therapies include β-agonists, glucagon, and phosphodiesterase inhibitors. However, in β-blocker poisoning where symptomatic bradycardia and hypotension are present, high-dose glucagon is considered the first-line antidote. Traditionally, antidotes for CCB overdose have included calcium, glucagon, adrenergic drugs, and amrinone. For cases of CCB poisoning where cardiotoxicity is evident, first-line therapy is a combination of calcium and epinephrine; high-dose insulin with supplemental dextrose and potassium therapy (HDIDK) is reserved for refractory cases. Health-system pharmacists should be aware that when these drugs are used as antidotes, higher than normal dosing is needed. Conclusion. Poisoning by β-blockers or CCBs usually produces hypotension and bradycardia, which may be refractory to standard resuscitation measures. For cases of β-blocker poisoning where symptomatic bradycardia and hypotension are present, high-dose glucagon is considered the first-line antidote. For cases of CCB poisoning where cardiotoxicity is evident, a combination of calcium and epinephrine should be used initially, reserving HDIDK for refractory cases.
Highly CitedHigh-dose glucagon is the first-line antidote for -blocker poisoning, while a combination of calcium and epinephrine is recommended for CCB poisoning, with HDIDK reserved for refractory cases.
Full text analysis coming soon...