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GREENE SHEPHERD, PHARM.D., DABAT, is Clinical Associate Professor, Medical College of Georgia, 1120 15th Street, CJ-1020, Augusta, GA 30912-2450 (jshepherd{at}mcg.edu).

Purpose. The toxic effects and treatment of ß-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, ß-blockers and CCBs have similar presentation and treatment overlaps and are often refractory to standard resuscitation measures. The common feature of ß-blocker toxicity is excessive blockade of the ß-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 ß-agonists, glucagon, and phosphodiesterase inhibitors. However, in ß-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 ß-blockers or CCBs usually produces hypotension and bradycardia, which may be refractory to standard resuscitation measures. For cases of ß-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. Index terms: Amrinone; Antidotes; Calcium; Calcium antagonists; Combined therapy; Dextrose; Dosage; Epinephrine; Glucagon; Insulin; Phosphodiesterase inhibitors; Poisoning; Potassium; Sympatholytic agents; Sympathomimetic agents; Toxicity

 

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