Ambloc Overdosage

Clinical effects of overdose: Symptomatic hypotension; Reflex tachycardia; Bradycardia.
Treatment of overdose: To decrease absorption: Ipecac is not recommended since emesis may produce vagal stimulation and (theoretically) worsen an overdose with calcium antagonists. Furthermore, Ipecac has not been demonstrated to improve patient outcome.
Consider prehospital administration of activated charcoal as an aqueous slurry in patients who are awake and able to protect their airway. Activated charcoal is most effective when administered within one hour of ingestion.
To enhance elimination: High protein binding of all calcium channel blocking agents would suggest hemodialysis or hemoperfusion would have limited usefulness.
Recommended treatment consists of the following: Hypotension, symptomatic: Intravenous fluids, Intravenous Dopamine or Dobutamine, Calcium Gluconate, Isoproterenol, Metaraminol, or Norepinephrine should be used as appropriate; Tachycardia, rapid ventricular rate in patients with antegrade conduction in atrial flutter fibrillation, and accessory pathway with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome- Direct-current cardioversion or intravenous Lidocaine, or intravenous Procainamide.
Intravenous fluids given by slow-drip; Bradycardia, rarely second or third degree atrioventricular (AV) block, with few patients progressing to asystole Intravenous Atropine, Isoproterenol, Norepinephrine, or Calcium chloride, or use of electronic cardiac pacemaker as appropriate.
Specific treatment: Supportive care: Patients in whom intentional overdose is confirmed or suspected should be referred for psychiatric consultation.
Monitoring: Patients with suspected calcium-channel blocker overdose should be placed on a cardiac monitor. Monitor hemodynamic status closely including heart rate blood pressure, EKG, and urinary output.
Monitor electrolytes, renal function tests and glucose. Swan Ganz monitoring may help guide fluid and hemodynamic management.
Monitor respiratory function and oxygenation; pulmonary edema may occur.
Calcium antagonist dosage forms are generally radiolucent. Sustained-release forms may be an exception.
Qualitative and/or quantitative serum levels for calcium antagonists are not readily available, predictive of toxicity, nor helpful in directing therapy.