BMJ 1994;309:193 (16 July)

Letters

Overdose of diltiazem

EDITOR, - T A Roper advocates that in cases of poisoning with the calcium antagonist diltiazem the drug's concentration should be measured, even though the assay is available only in specialised centres.1 Roper suggests that there is a correlation between clinical sequelae and the diltiazem concentration after overdose. Concentrations of the calcium antagonists do not, however, usually correlate well with clinical outcome after overdose,2 and routine measurements would be of little value. For example, death has been reported with diltiazem concentrations as low as 1500 µg/l and survival with concentrations as high as 6090 µg/l.34 Similarly, verapamil concentrations have been as low as 1500 µg/l in patients who have died and as high as 4000 µg/l in survivors.2 Nifedipine is technically difficult to measure as the compound is photosensitive. In addition, peak concentrations of the newer, sustained release preparations of these drugs are delayed, and concentrations on admission may be . . . [Full text of this article]


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