BMJ 1994;308:992-993 (16 April)

Editorials

Treating overdose with calcium channel blockers

Calcium channel blockers are widely used in the management of diverse cardiovascular conditions, including hypertension, arrhythmias, and angina.1 As their use increase so overdose with them has become more common, and the management of patients who have taken an overdose presents a formidable therapeutic challenge.2

The drugs' toxic effects in overdose can be predicted from their clinical pharmacology. By modifying the transport of calcium ions across membranes in the myocardium and vascular smooth muscle the drugs cause vasodilatation, reduced myocardial contractility, and depressed sinoatrial and atrioventricular conduction. Although the therapeutic effects differ according to the drug (nifedipine produces vasodilatation; verapamil affects conduction), in overdose the effects are similar.3

The central nervous, cardiovascular, and gastrointestinal systems and glucose metabolism may all be affected. The clinical effects usually develop within 30 to 60 minutes of ingestion of an overdose of five to 10 times the therapeutic dose. Central nervous system features include . . . [Full text of this article]


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  • Varpula, T., Rapola, J., Sallisalmi, M., Kurola, J. (2009). Treatment of Serious Calcium Channel Blocker Overdose With Levosimendan, a Calcium Sensitizer. Anesth. Analg. 108: 790-792 [Abstract] [Full text]  
  • Patel, N. P., Pugh, M. E., Goldberg, S., Eiger, G. (2007). Hyperinsulinemic Euglycemia Therapy for Verapamil Poisoning: A Review. Am J Crit Care 16: 498-503 [Abstract] [Full text]  
  • Harris, N. S. (2006). Case 24-2006 -- A 40-Year-Old Woman with Hypotension after an Overdose of Amlodipine. NEJM 355: 602-611 [Full text]  
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  • Isbister, G K (2002). Delayed asystolic cardiac arrest after diltiazem overdose; resuscitation with high dose intravenous calcium. Emerg. Med. J. 19: 355-357 [Abstract] [Full text]  
  • Stevens, J J W M (1994). Overdose of calcium channel blockers. BMJ 309: 193b-193 [Full text]  
  • Buckley, N A, Whyte, I M, Dawson, A H (1994). Overdose with calcium channel blockers. BMJ 308: 1639-1639 [Full text]  
  • Roper, T A (1994). Overdose of diltiazem. BMJ 308: 1571-1571 [Full text]  
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