BMJ 1994;308:1639 (18 June)

Letters

Overdose with calcium channel blockers

EDITOR, - John Kenny's editorial on overdose with calcium channel blocking drugs made several statements that could be misinterpreted with potentially serious results.1 Calcium channel blockers had similar effects in overdose despite differing therapeutic effects. A range of similar adverse effects have been reported in case reports, but death, and life threatening complications such as heart block and refractory hypotension, are much more common with verapamil than diltiazem.2,3 Similarly, these effects are more common with diltiazem than nifedipine (and presumably other dihydropyridines).2,3 This mirrors their relative effects on cardiac conduction in therapeutic doses. There have been no deaths formally reported with nifedipine poisoning alone.3 Most nifedipine poisonings will respond to supportive treatment with intravenous fluids. Verapamil, in contrast, frequently causes profound bradycardia and hypotension and warrants aggressive and intensive therapy.

We agree that the initial treatment of choice is calcium, but the suggestion that four doses of 1 g (or . . . [Full text of this article]


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Relevant Article

Treating overdose with calcium channel blockers
J Kenny
BMJ 1994 308: 992-993. [Extract] [Full Text]

This article has been cited by other articles:

  • 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]  
  • 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]  
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