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Calcium Channel Blocker Poisoning

Toxic doses of drugs such as verapamil and diltiazem can cause life-threatening hypotension and bradycardia.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Calcium Channel Blocker Poisoning?

Calcium channel blocker (CCB) intoxication carries high mortality, especially with non-dihydropyridine agents (verapamil, diltiazem) due to cardiac depressant effects.

Blockade of L-type calcium channels suppresses myocardial contractility, sinus node automaticity and AV conduction. Hyperglycemia is a characteristic laboratory finding.

Treatment is multimodal; calcium salts, glucagon, high-dose insulin euglycemia, vasopressors and in refractory cases lipid emulsion and ECMO may be used.

Symptoms

Hypotension
Bradycardia and AV block
Cardiogenic shock
Nausea and vomiting
Hyperglycemia
Pulmonary edema
Confusion and loss of consciousness

Risk Factors

Suicidal mass drug ingestion
Ingestion of extended-release forms (delayed worsening)
Elderly patients
Renal and hepatic failure
Concomitant beta-blocker use
Wrong dose in children
Commercial pill mix-up

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Go to the ER immediately for high-dose verapamil, diltiazem or amlodipine ingestion
  • Call 112 for bradycardia, syncope and hypotension
  • A single tablet can be lethal in a child
  • Delayed symptoms may occur with extended-release drugs

Treatment Methods

01
Early activated charcoal (delayed in extended-release forms)
02
IV calcium gluconate or calcium chloride
03
Vasopressors (norepinephrine, epinephrine)
04
Glucagon infusion
05
High-dose insulin euglycemia (HIE) protocol
06
IV lipid emulsion (Intralipid)
07
VA-ECMO in refractory cases
08
Intensive care monitoring

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.