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Calcium channel blocker poisoning

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Calcium channel blocker (CCB) overdoses are associated with significant morbidity and mortality.

CCBs are classified into two main clinical categories based on their physiological effects:

  • dihydropyridines (eg, amlodipine, nifedipine, felodipine, nicardipine)
  • non-dihydropyridines (eg, verapamil and diltiazem)

Severe CCB toxicities may present with life-threatening bradycardia, hypotension, hyperglycemia, and renal insufficiency (1)

  • dihydropyridine toxicity, however, may present with reflex tachycardia instead of bradycardia
    • dihydropyridines have a greater affinity for peripheral vascular smooth muscle cells, while nondihydropyridines have a greater affinity for cardiomyocytes

A review found that verapamil and diltiazem are more toxic calcium channel blockers in overdose compared to dihydropyridines (2).

Reference:

  1. Alshaya OA et al. Calcium Channel Blocker Toxicity: A Practical Approach. J Multidiscip Healthc. 2022 Aug 30;15:1851-1862.
  2. Isbister GK, Jenkins S, Harris K, Downes MA, Isoardi KZ. Calcium channel blocker overdose: Not all the same toxicity. Br J Clin Pharmacol. 2024; 1-8.

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