What is calcium channel blocker (CCB) toxicity?

Updated: Jan 04, 2021
  • Author: B Zane Horowitz, MD, FACMT; Chief Editor: Michael A Miller, MD  more...
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Answer

Calcium channel blocker (CCB) toxicity is one of the most lethal prescription drug overdoses; therefore, understanding the emergent management of such cases is essential. Overdoses of immediate-release CCBs are characterized by rapid progression to hypotension, bradydysrhythmia, and cardiac arrest. Overdoses of extended-release formulations can result in delayed onset of dysrhythmias, shock, sudden cardiac collapse, and bowel ischemia. [1]

Among the most widely prescribed drugs in the United States, CCBs are used to treat angina, hypertension, and dysrhythmias and to prevent migraines. They are marketed under many brand names, in a range of doses and formulations. Because they are found in many households and children may sometimes mistake them for candy, unintentional ingestion of CCBs is common. In addition, pediatricians have used these agents to treat children (eg, those with congenital heart malformations) for conditions such as dysrhythmias, hypertension, and chronic heart failure. Thus, dosing errors are also a possible source of toxicity in this age group.

These medications have different onsets of action, and many are available in sustained-release forms, all of which complicates the physician's decision regarding the appropriate duration of monitoring for patients with a history of CCB ingestion. (See Presentation and Workup.)

Patients with CCB toxicity should be treated in a well-equipped emergency facility or in an intensive care setting. Numerous strategies for treating patients who have ingested CCBs are available. (See Treatment.)


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