How is calcium channel blocker (CCB) toxicity treated?

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

Basic supportive care is the first, and possibly most important, mode of management for calcium channel blocker (CCB) toxicity: Establish and secure the airway and breathing, and focus on preserving adequate circulation (ABCs). Crystalloid fluid boluses can be given, and atropine for symptomatic bradycardia. [21] Correction of acid-base disturbances and electrolyte abnormalities is also important, to optimize cardiac function.

Because CCB blood concentrations are generally not available with any reasonable turnaround time, treatment must be instituted on the basis of signs and symptoms. Blood concentrations can be used to confirm the diagnosis if it is in doubt. [22, 23]

Activated charcoal has been demonstrated to significantly absorb immediate-release medications within 1 hour of ingestion and extended-release medications as long as 4 hours after ingestion. [4] Before administration of activated charcoal, protect the patient's airway to prevent vomiting and aspiration.

In addition, extended-release tablets have a delayed onset of up to 12-24 hours; therefore, prematurely releasing a patient who has ingested an extended-release tablet from emergency or intensive care observation too soon places him or her in jeopardy.

Admit all patients with CCB ingestion to ICU monitoring for 6-12 hours in cases of standard-release preparation overdose, and for 24-36 hours in cases of extended-release or once-a-day preparation overdose. In cases of intentional overdose, patients who remain asymptomatic after an adequate observation time may be referred for psychiatric evaluation.

Consult an American Association of Poison Control Centers–certified regional poison control center in all cases to assist in management, because poisonings can be quite severe and dynamic and treatment is often complicated and multimodal. For these reasons, when patients are critically ill, besides the initial discussion with the certified specialist in poison information, request to speak with the medical toxicologist on call. When calling a poison control center, be prepared to give as much information as possible during the initial call. Estimate amount and type of drug ingested, elapsed time since ingestion, and time treatment was started.

Poison control centers can also provide monitoring guidelines for asymptomatic patients, according to the potency and onset, and duration of action of the ingested CCB. Generally, however, the recommended duration of clinical observation for patients with significant exposure to CCBs is as follows [2, 3] :

  • Immediate-release products: 6 hours
  • Standard-release products: 6-12 hours
  • Extended-release or once-a-day preparations: 24-36 hours

Many poison control centers make follow-up calls to offer additional management recommendations and learn patient outcomes. The physician can supply additional information at that time.


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