Carivalan Overdosage

There is no information on overdose with Carvedilol + Ivabradine (Carivalan) in humans.
Symptoms: Linked to carvedilol: In case of an overdose, severe hypotension, bradycardia, heart failure, cardiogenic shock and cardiac arrest may occur. Respiratory distress, bronchospasm, vomiting, altered consciousness and generalized seizures may also occur.
Linked to ivabradine: Overdose may lead to severe and prolonged bradycardia.
Management: In addition to general procedures, vital signs must be monitored and corrected, if necessary under intensive care conditions. Within 4 hours after ingestion, the absorption of carvedilol in the gastrointestinal tract can be reduced through gastric lavage, activated charcoal and induced vomiting.
Patients should be placed in the supine position. Atropine, 0.5 mg to 2 mg intravenous (i.v.) and/or glucagon 1 to 10 mg i.v. (followed by a slow i.v. infusion of 2 to 5 mg/hour if necessary) may be given when severe bradycardia is present, which should be treated symptomatically in a specialized environment. To support ventricular function, intravenous administration of glucagon, or sympathomimetics (e.g. dobutamine, isoprenaline, orciprenaline, adrenaline and in accordance to body weight and effect) are recommended. In the event of bradycardia with poor hemodynamic tolerance, symptomatic treatment including intravenous beta-stimulating medicinal products such as isoprenaline may be considered temporary cardiac electrical pacing may be instituted if required. Extensive hypotension may be treated with administration of intravenous fluids.
If positive inotropic effect is required, phosphodiesterase inhibitors, e.g. milrone, should be considered. In the case of drug-resistant bradycardia, the initiation of pacemaker therapy may be required. If peripheral vasodilation dominates in the intoxication profile then norfenefrine or noradrenaline should be administered, with continuous monitoring of the circulation, either 5 to 10 micrograms i.v., repeated according to arterial blood pressure response, or 5 micrograms per minute by infusion titrated to arterial blood pressure.
For bronchospasm, β-sympathomimetics (as aerosol or intravenous) should be given, or aminophylline may be administered intravenously by slow injection or infusion.
In the event of seizures, slow intravenous injection of diazepam or clonazepam is recommended.
In cases of severe overdose with symptoms of shock, supportive treatment must be continued for a sufficiently long period, as a prolongation of elimination half-life and redistribution of carvedilol from deeper compartments are to be expected. Therefore, supportive treatment should be continued until the patient's condition has stabilized. The length of the treatment depends on the severity of the overdose.
Carvedilol + Ivabradine (Carivalan) is not eliminated by dialysis, since the active substance cannot be dialyzed, presumably due to its high degree of plasma protein binding.