Klin Farmakol Farm. 2023;37(4):152-155 | DOI: 10.36290/far.2023.026

Calcium channel blocker intoxications

Marek Pecha
Ústav farmakologie Fakultní nemocnice Olomouc a Lékařské fakulty Univerzity Palackého v Olomouci

Calcium channel blocker intoxications are not common despite their widespread use, but are often severe and have a high mortality. In any intoxication, the cause should be investigated to prevent recurrence. This is particularly relevant for suicidal intent. Hypotension is the most common manifestation of poisoning, often accompanied by hyperglycaemia. The effect on heart rate depends on the specific drug and the dose ingested. The treatment is individually tailored according to the severity of intoxication, clinical condition and comorbidities - from observation and intestinal decontamination, through specific therapy - calcium and insulin administration to approaches reserved for the most serious conditions such as vasopressors administration and ECMO theraphy.

Keywords: calcium channel blockers, poisoning, treatment.

Accepted: December 13, 2023; Published: December 20, 2023  Show citation

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Pecha M. Calcium channel blocker intoxications. Klin Farmakol Farm. 2023;37(4):152-155. doi: 10.36290/far.2023.026.
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    References

    1. Frishman WH. Calcium channel blockers: differences between subclasses. Am J Cardiovasc Drugs. 2007;7:17-23. Go to original source... Go to PubMed...
    2. Zdroj SÚKL https://www.sukl.cz/leciva/rok-2022.
    3. Widimský J, Filipovský J, Ceral J, et al. Rosolová Diagnostické a léčebné postupy u arteriální hypertenze Doporučení České společnosti pro hypertenzi. Hypertenze & kardiovaskulární prevence 2022 č.2.
    4. Fiala M, Haman L, Čihák R. Doporučení ESC pro diagnostiku a léčbu fibrilace síní, 2020. Souhrn dokumentu připravený Českou kardiologickou společností. Cor Vasa 2021;63:135-161. Go to original source...
    5. Gummin DD, Mowry JB, Beuhler MC, et al. 2021 Annual Report of the National Poison Data System© (NPDS) from America's Poison Centers: 39th Annual Report. Clin Toxicol (Phila). 2022;60(12):1381-1643. Go to original source... Go to PubMed...
    6. Matalova P, Buchta M, Drietomska V, et al. Acute drug intoxication in childhood: a 10-year retrospective observational single-centre study and case reports. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023;167(3):294-302. Go to original source... Go to PubMed...
    7. Gummin DD, Mowry JB, Beuhler MC, et al. 2021 Annual Report of the National Poison Data System© (NPDS) from America's Poison Centers: 39th Annual Report. Clin Toxicol (Phila). 2022;60(12):1381-1643. Go to original source... Go to PubMed...
    8. https://www.tis-cz.cz/images/stories/PDFs/zprava_o_cinnosti_TIS_2022.pdf.
    9. Stanek EJ, Nelson CE, DeNofrio D. Amlodipine overdose. Ann Pharmacother. 1997;31(7-8):853-856. Go to original source... Go to PubMed...
    10. Pecha M, Halouzka V, Daniš L, et al. Otrava lerkanidipinem Klin Farmakol Farm. 2022;36(3):115-117. Go to original source...
    11. Minish T, Herd A. Symptomatic bradycardia secondary to interaction between topical timolol maleate, verapamil, and flecainide: a case report. J Emerg Med. 2002;22(3):247-249. Go to original source... Go to PubMed...
    12. Saedder EA, Thomsen AH, Hasselstrøm JB, et al. Heart insufficiency after combination of verapamil and metoprolol: A fatal case report and literature review. Clin Case Rep. 2019;7(11):2042-2048. Go to original source... Go to PubMed...
    13. Pringle SD, MacEwen CJ. Severe bradycardia due to interaction of timolol eye drops and verapamil. Br Med J (Clin Res Ed). 1987;294(6565):155-156. Go to original source... Go to PubMed...
    14. SPC přípravku Kapidin. Available from: https://www.sukl.cz/download/spc/SPC7512.pdf.
    15. Amorim S, Dias P, Rocha G, et al. Poisoning with calcium channel blockers--a case report and review of the literature. Rev Port Cardiol. 2001;20(12):1249-1257.
    16. Brass BJ, Winchester-Penny S, Lipper BL. Massive verapamil overdose complicated by noncardiogenic pulmonary edema. Am J Emerg Med. 1996;14(5):459-461. Go to original source... Go to PubMed...
    17. Kline JA, Raymond RM, Schroeder JD, et al. The diabetogenic effects of acute verapamil poisoning. Toxicol Appl Pharmacol. 1997;145(2):357-362. Go to original source... Go to PubMed...
    18. Levine M, Boyer EW, Pozner CN, et al. Assessment of hyperglycemia after calcium channel blocker overdoses involving diltiazem or verapamil. Crit Care Med. 2007;35(9):2071-2075. Go to original source... Go to PubMed...
    19. Engebretsen KM, Kaczmarek KM, Morgan J, et al. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila). 2011;49(4):277-283. Go to original source... Go to PubMed...
    20. Osman AF, Prasad RM, Marein S, et al. Multi-organ dysfunction as a presentation of calcium channel blocker intoxication. BMJ Case Rep. 2022;15(1):e245711. Go to original source... Go to PubMed...
    21. Alsarra IA. High-performance liquid chromatographic method for quantitative determination of amlodipine in human plasma and pharmaceutical dosage form and its application to pharmacokinetic studies. J Chromatogr Sci. 2009;47(10):863-867. Go to original source... Go to PubMed...
    22. Barrueto F. "Calcium Channel Blocker Poisoning." UpToDate, May 2023, www.uptodate.com/contents/calcium-channel-blocker-poisoning (cited 7. 12. 2023).
    23. Olson KR, Erdman AR, Woolf AD, et al. American Association of Poison Control Centers. Calcium channel blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(7):797-822. Go to original source... Go to PubMed...
    24. St-Onge M, Anseeuw K, Cantrell FL, et al. Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. Crit Care Med. 2017;45(3):e306-e315. Go to original source... Go to PubMed...
    25. Laine K, Kivistö KT, Laakso I, et al. Prevention of amlodipine absorption by activated charcoal: effect of delay in charcoal administration. Br J Clin Pharmacol. 1997;43(1):29-33. Go to original source... Go to PubMed...
    26. Večeřa R, Ondra P, Jezdinský J, et al. Výplach žaludku při perorální intoxikaci-sporné pohledy na problematiku [Gastric lavage after peroral intoxication--controversial views]. Cas Lek Cesk. 2015;154(4):174-175.
    27. Hopkins LE, Sunkersing J, Jacques A. Too many pills to swallow: A case of a mixed overdose. J Intensive Care Soc. 2017;18(3):247-250. Go to original source... Go to PubMed...
    28. Taylor JR, Streetman DS, Castle SS. Medication bezoars: a literature review and report of a case. Ann Pharmacother. 1998;32(9):940-946. Go to original source... Go to PubMed...
    29. Niezabitowski LM, Nguyen BN, Gums JG. Extended-release nifedipine bezoar identified one year after discontinuation. Ann Pharmacother. 2000;34(7-8):862-864. Go to original source... Go to PubMed...
    30. Doukky R, Bargout R, Kelly RF, et al. Using transcutaneous cardiac pacing to best advantage: How to ensure successful capture and avoid complications. J Crit Illn. 2003;18(5):219-225.
    31. Rothschild L, Bern S, Oswald S, et al. Intravenous lipid emulsion in clinical toxicology. Scand J Trauma Resusc Emerg Med. 2010;18:51. Go to original source... Go to PubMed...
    32. Wong A, Hoffman RS, Walsh SJ, et al. Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol (Phila). 2021;59(5):361-375. Go to original source... Go to PubMed...
    33. Beyls C, Malaquin S, Huette P, et al. Hemodynamic impact of molecular adsorbent recirculating system in refractory vasoplegic shock due to calcium channel blocker poisoning. Int J Artif Organs. 2021;44(12):944-951. Go to original source... Go to PubMed...

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