Calcium channel blocker poisoning
Calcium channel blocker (CCB) overdoses are associated with significant morbidity and mortality.
CCBs are classified into two main clinical categories based on their physiological effects:
- dihydropyridines (eg, amlodipine, nifedipine, felodipine, nicardipine)
- non-dihydropyridines (eg, verapamil and diltiazem)
Severe CCB toxicities may present with life-threatening bradycardia, hypotension, hyperglycaemia, and renal insufficiency (1)
- dihydropyridine toxicity, however, may present with reflex tachycardia instead of bradycardia
- dihydropyridines have a greater affinity for peripheral vascular smooth muscle cells, while non-dihydropyridines have a greater affinity for cardiomyocytes
A review found that verapamil and diltiazem are more toxic calcium channel blockers in overdose compared to dihydropyridines (2).
Reference:
- Alshaya OA et al. Calcium Channel Blocker Toxicity: A Practical Approach. J Multidiscip Healthc. 2022 Aug 30;15:1851-1862.
- Isbister GK, Jenkins S, Harris K, Downes MA, Isoardi KZ. Calcium channel blocker overdose: Not all the same toxicity. Br J Clin Pharmacol. 2024; 1-8.
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