Symptomatic beta blocker overdose is a relatively uncommon, but potentially life-threatening condition (Sheppard, 2006 Health Protection Agency, 2010). For cases of CCB poisoning where cardiotoxicity is evident, a combination of calcium and epinephrine should be used initially, reserving HDIDK for refractory cases.Glucagon treatment for symptomatic beta blocker overdose For cases of beta-blocker poisoning where symptomatic bradycardia and hypotension are present, high-dose glucagon is considered the first-line antidote. Health-system pharmacists should be aware that when these drugs are used as antidotes, higher than normal dosing is needed.ĬONCLUSION: Poisoning by beta-blockers or CCBs usually produces hypotension and bradycardia, which may be refractory to standard resuscitation measures. 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. Traditionally, antidotes for CCB overdose have included calcium, glucagon, adrenergic drugs, and amrinone. However, in beta-blocker poisoning where symptomatic bradycardia and hypotension are present, high-dose glucagon is considered the first-line antidote. Therapies include beta-agonists, glucagon, and phosphodiesterase inhibitors. Poisoning by CCBs is characterized by cardiovascular toxicity with hypotension and conduction disturbances, including sinus bradycardia and varying degrees of atrioventricular block.

The common feature of beta-blocker toxicity is excessive blockade of the beta-receptors resulting in bradycardia and hypotension. In overdose, beta-blockers and CCBs have similar presentation and treatment overlaps and are often refractory to standard resuscitation measures.

Beta-blockers and CCBs represent the most important classes of cardiovascular drugs. SUMMARY: Overdoses with cardiovascular drugs are associated with significant morbidity and mortality.

PURPOSE: The toxic effects and treatment of beta-adrenergic blocker and calcium-channel blocker (CCB) overdose are reviewed.

Beta blocker toxicity antidote