Acute amlodipine overdose treated by high dose intravenous calcium in a patient with severe renal insufficiency. They may actually present with reflex tachycardia. This is a preview of subscription content, log in to check access. One notable case of massive lipid overdose reported by West et al. Intoxication with 280 mg of amlodipine caused severe hypotension, third‐degree heart block and hyperkalaemia in a 36‐year‐old female patient. 2010 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th annual report. Plasma concentrations of amlodipine were measured in serial samples by gas chromatography. Special considerations • Because the vasodilation induced by amlodipine is gradual in onset, acute hypotension has rarely been reported after oral administration. Serum potassium was normal 3.3 mmol/l, lactate dehydrogenase slightly elevated to 566 U/l, and creatinine elevated to 136 μmol/l. On the day after the ingestion of amlodipine the general practitioner found the patient fully conscious, mildly flushing, without oedemas and with a blood pressure of 115/60 mmHg. Intoxication with calcium channel blocking agents has primarily been described for drugs such as diltiazem, verapamil and nifedipine, whereas there is limited clinical experience with amlodipine intoxication (Rasmussen et al. There was no conduction abnormalities or rythm disorders. Acute amlodipine overdose treated by high dose intravenous calcium in a patient with severe renal insufficiency. The amlodipine tablets used for the suicide attempt were prescribed for the patient's wife, who also provided information about the amount taken. Treatment of calcium channel blocker intoxication with insulin infusion: case report and literature review. -, Russel RP. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. 1998;16(5):527–528. Haddad LM. A witnessed a severe Nicardipene overdose in the setting of CABG during the harvesting of saphenous. Blockade of calcium channels in cardiac muscle results in negative inotropic and chronotropic effects. 14 involved a 72-yr-old patient with severe amlodipine overdose; 2 l of 20% lipid emulsion were infused because of confusion about the treatment protocol. (2) Amlodipine, a dihydropyridine CCB, can cause prolonged hypotension in overdose. Transvenous pacing has been reported in several cases with unclear clinical benefit, and balloon pump and bypass have also been reported to be used with succes, but data are limited (Salhanick & Shannon 2003). (Redirected from Amlodipine overdose) Calcium channel blocker toxicity is the taking of too much of the medications known as calcium channel blockers (CCBs), either by accident or on purpose. Cardiovasc Toxicol. Calcium channel blockers in clinical use include phenylalkylamines (e.g., verapamil), benzothiazepines (e.g., diltiazem) and dihydropyridines (e.g., amlodipine). She then received hyperinsulinemia euglycemia therapy. Toxicity is generally managed with fluid replacement monitoring ECG results, vital signs, respiratory system function, glucose … NIH Different dosing regimens have been employed. Although rare, amlodipine overdose toxicity can result in widening of blood vessels, severe low blood pressure, and fast heart rate. After oral administration amlodipine is slowly absorbed, and peak plasma concentrations are observed after 6 to 9 hr (Haria & Wagstaff 1995), and elimination half‐life at first dose is 45.6±10 hr, which is the longest half‐life of all calcium channel blockers (Donnelly et al. Amlodipine belongs to a class of drugs known as calcium channel blockers. The patient was initially treated with fluids, calcium gluconate, and Dobutamine without effect. Severe amlodipine intoxication treated by hyperinsulinemia euglycemia therapy. Journal of Critical Care. 2011;49(10):910–941. One notable case of massive lipid overdose reported by West et al. Learn more. Treatment of patients with CCB overdose remains challenging especially in those with refractory hypotension and end organ dysfunction. Overdose symptoms will vary, depending on a number of factors, but may include dizziness, lightheadedness, fainting, and feelings of a rapidly or forcefully beating heart. Faulkner et al. (1986) have evaluated the pharmacokinetics of amlodipine after single intravenous and oral doses and its pharmacokinetics after repeated oral doses in healthy male volunteers (table 2 and 3). Overdose can result in heart failure, a very slowed heart rate, severe hypo-tension (low blood pressure), and secondary acute kidney failure. Peak level was 143 ng/ml 64.5 hr after ingestion. Treatment for an overdose can involve "pumping the stomach," taking certain medicines, or supportive care. The present case is compared with previous reported cases of amlodipine overdose where patients all developed severe symptoms. b.i.d. Intoxication with 280 mg of amlodipine caused severe hypotension, third-degree heart block and hyperkalaemia in a 36-year-old female patient. ... and its clinical potential is underrecognized in the management of severe CCB toxicity. Adams BD, Browne WT. This report describes a severe amlodipine overdose case that was refractory to multiple therapeutic approaches. Previously reported cases of amlodipine overdoses are summarised in table 4. 40mg of Nicardipene infused rapidly into central line – straight to the heart. A 53-year-old male presented after ingesting eighty 10 mg amlodipine tablets in a suicide attempt. major cause of cardiovascular drug overdose that o en leads to a lethal outcome. 1994). Severe intoxication after an intentional overdose of amlodipine. His blood pressure was 140/70 mmHg, and ECG showed sinus tachycardia, 103 beats/min. Clin Toxicol (Phila). Amlodipine is a calcium channel blocker that dilates (widens) blood vessels and improves blood flow. 1994). This can progress to the heart stopping altogether. The following day, his doctor found him fully conscious with mild flushing. Case presentation: A 49-year-old white woman with known bilateral early optic atrophy presented to our hospital with hypotension and obtundation following a known ingestion of 150 mg of amlodipine. Plasma concentrations of amlodipine were measured in serial samples by gas chromatography. SEVERE … This selectivity is not lost in overdose. We report the case of an intoxication with amlodipine, which caused severe hypotension, in a young woman. She then received hyperinsulinemia euglycemia therapy. Overdose of this commonly used drug can result in negative physiologic consequences including severe hypotension and even death due to metabolic and hemodynamic compromise. This paper describes a case of severe amlodipine overdose with no other concomitant overdose. Amlodipine is also used to treat high blood pressure (hypertension). The patient was observed for 2 days and had no complaints related to the amlodipine overdose. The present case is compared with previous reported cases of amlodipine overdose where patients all developed severe symptoms. COVID-19 is an emerging, rapidly evolving situation. Amlodipine is a dihydropyridine calcium channel blocker (CCB) and is usually well tolerated up to 10 mg daily dose. compared with previous reported cases of amlodipine overdose where patients all developed severe symptoms. The patient was initially treated with fluids, dopamine, calcium chloride, and epinephrine without effect. Overdose of verapamil or diltiazem greater than 300 mg carries a significant risk of death and potentially life threatening arrhythmias occur with lower doses (Howarth et al. We report the fatal case of an amlodipine overdose, which caused intractable acidosis and cardiovascular failure in … medication overdose cases. We conclude that amlodipine overdose does not always cause severe symptoms. He was retired early from a job as independent heating and sanitary engineer due to severe and immobilizing gout. Acute amlodipine overdose treated by high dose intravenous calcium in a patient with severe renal insufficiency Yao-Min Hung Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan , M.D. Clinical Toxicology. "Severe Intoxication After an Intentional Overdose of Amlodipine." Acute amlodipine overdose treated by high dose intravenous calcium in a patient with severe renal insufficiency. 45(3):301-3. . Get emergency help immediately if any of the following symptoms of overdose occur while taking amlodipine / atorvastatin: Symptoms of overdose. Amlodipine is also used to prevent certain types of chest pain (angina). -, Abernethy DR, Schwartz JB. Decontamination should be aggressive and charcoal should be routinely administered. Single oral amlodipine maleate doses equivalent to 4 or more mg amlodipine/kg or higher in dogs (11 or more times the maximum recommended human dose on a mg/m 2 basis) caused a marked peripheral vasodilation and hypotension. We conclude that amlodipine overdose does not always cause severe symptoms. The present case is compared with previous … Continuous calcium therapy followed by a phosphodiesterase inhibitor, glucagon, and adrenergic agents added in a stepwise fashion constitutes a rational progression of therapy if symptoms of toxicity persists. 2003 May;57(2):211-3. doi: 10.1016/s0300-9572(03)00026-1. A rise in blood pressure (BP) was observed two hours after insulin was started. Bailey B. Glucagon in beta‐blocker and calcium channel blocker overdoses: a systematic review. Resuscitation. The typical presentation of a calcium channel blocker overdose is hypotension and decreased level of … Mechanical supportive measures may be necessary in the setting of failure of pharmacological therapy. 47, no. If massive overdose should occur, initiate active cardiac and respiratory monitoring. We report the case of an intoxication with amlodipine, which caused severe hypotension, in a young woman. There was no concomitant overdose. 1 Additional side effects include drowsiness, nausea, vomiting, peripheral vasodilation, shock, metabolic acidosis, acute renal failure, respiratory failure and/or hypoxemia. The positive inotropic effect of insulin therapy in our patient supports previous findings that suggest its use as a first-line therapy in the management of CCBs overdose. Epub 2018 Feb 11. CASE REPORT Abstract Background: Calcium channel blocker (CCB) toxicity is … Metrics details. Plasma concentrations of amlodipine were measured by gas chromatography in serial samples drawn at 12 hr interval (table 1) (Bioanalytisches Labor, Heinrich Mack Nachf., Illertissen, Germany) (Beresford et al.1987). Amlodipine is a dihydropyridine calcium channel blocking agent used in the treatment of essential hypertension and angina pectoris. 14involved a 72-yr-old patient with severe amlodipine overdose; 2 l of 20% lipid emulsion were infused because of confusion about the treatment protocol. [ 11] T The clinical effects of amlodipine are similar to those of nicardipine. We report a case of severe mixed amlodipine and losartan overdose causing refractory hypotension resistant to all conventional vasopressors and hyperinsulinaemia-euglycaemia, but responsive to a metaraminol infusion. We report here an unusual case whereby the patient self-medicated herself with amlodipine 10 mg p.o. 2 Citations. Because amlodipine is highly protein-bound, hemodialysis isn’t likely to benefit the patient. We present a case of young man with amlodipine toxicity successfully managed with high dose of IV insulin therapy. No gastrointestinal decontamination was performed. If you do not receive an email within 10 minutes, your email address may not be registered, 2010 Jan;38(1):33-5. doi: 10.1016/j.jemermed.2007.11.077. Although rare, amlodipine overdose toxicity can result in widening of blood vessels, severe low blood pressure, and fast heart rate. 1988;11(3, part 2):II42–II44. The New England Journal of Medicine. Plasma concentrations of amlodipine were measured in serial samples by gas chromatography. Acta Anaesthesiologica Scandinavica, vol. She then received hyperinsulinemia euglycemia therapy. Treatment for calcium channel blocker poisoning: a systematic review. We report one such case of overdose of amlodipine-atenolol treated with traditional treatment measures along with levosimendan. Graham: I think lipid emulsion therapy (LET) for the treatment of severe CCB overdose is promising, but not yet ready for prime time. She developed hypotension and bradycardia and required hyperinsulinaemia‐euglycaemia therapy to reverse cardiovascular collapse (Boyer & Shannon 2001). 2003). / Journal of Applied Pharmaceutical Science 6 (01); 2016: 153-155 CASE REPORT of insulin and increased insulin … Successful treatment with integrated Chinese and western medicine for severe overdose of amlodipine: A case report. Clin Toxicol (Phila). Nevertheless, they remain a major cause of cardiovascular drug overdose that often leads to a lethal outcome. 1986). We conclude that amlodipine overdose does not always cause severe symptoms. In the present case, similar high amlodipine plasma concentrations were found as in previous cases. This site needs JavaScript to work properly. Calcium channel blockers (CCBs) are prescribed in a wide variety of cardiovascular conditions. A 54-year-old female presented after taking an overdose of an unknown amount of hydrochlorothiazide, doxazocin, atenolol and amlodipine. AU - Poggenborg,René Panduro, AU - Videbaek,Lars, AU - Jacobsen,Ib Abildgaard, PY - 2006/8/26/pubmed PY - 2007/2/14/medline PY - 2006/8/26/entrez SP - 209 EP - 12 JF - Basic & clinical pharmacology & toxicology JO - Basic Clin Pharmacol Toxicol VL - 99 IS - 3 N2 - A case of severe amlodipine overdose with only mild symptoms is described. The patient was initially treated with fluids, calcium gluconate, and Dobutamine without effect. 2018 Nov 25;2018:5864658. doi: 10.1155/2018/5864658. Overdose of this commonly used drug can result in negative physiologic consequences including severe hypotension and even death due to metabolic and hemodynamic compromise. Amlodipine is used with or without other medications to treat high blood pressure. The average concentration of amlodipine after 14 repeated oral doses of 15 mg given once daily is 14.5±5.8 ng/ml measured the last day (Faulkner et al. Plasma concentrations of amlodipine were measured in serial samples by gas chromatography. -, Leone M, Charvet A, Delmas A, Albanèse J, Martin C, Boyle WA.