What is the role of vasopressor therapy in the treatment of 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

If volume expansion does not raise the blood pressure to the desired level, vasopressors (eg, norepinephrine, epinephrine) can stimulate myocardial contractility and cause vasoconstriction, thus supporting blood pressure and cardiac output. In the hypotensive and bradycardic patient, administer dopamine initially at medium-to-high doses early to support the heart rate. Failure to respond to the maximal dose of dopamine should prompt the addition of norepinephrine.

Various combinations of dopamine, norepinephrine, epinephrine, phenylephrine, vasopressin, and metaraminol have all been used in cases of hypotension and shock. [1, 2, 33, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45] Inamrinone, a phosphodiesterase inhibitor with inotropic activity, may be of additional benefit in profound cardiac contractile failure. [34, 42, 46] Bedside cardiac echocardiography may help distinguish cardiogenic shock form vasodilatory shock.


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