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| __NOTOC__
| | #REDIRECT [[Diltiazem#Overdosage]] |
| {{Diltiazem}}
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| {{CMG}}; {{AE}} {{AK}}
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| ==OVERDOSAGE==
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| The oral LD50s in mice and rats range from 415 to 740 mg/kg and from 560 to 810 mg/kg, respectively. The intravenous LD50s in these species were 60 and 38 mg/kg, respectively. The oral LD50 in dogs is considered to be in excess of 50 mg/kg, while lethality was seen in monkeys at 360 mg/kg.
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| The toxic dose in man is not known. Due to extensive metabolism, blood levels after a standard dose of diltiazem can vary over tenfold, limiting the usefulness of blood levels in overdose cases.
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| There have been reports of diltiazem overdose in amounts ranging from <1 g to 18 g. Of cases with known outcome, most patients recovered and in cases with a fatal outcome, the majority involved multiple drug ingestion.
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| Events observed following diltiazem overdose included [[bradycardia]], [[hypotension]], [[heart block]], and [[cardiac failure]]. Most reports of overdose described some supportive medical measure and/or drug treatment. [[Bradycardia ]]frequently responded favorably to [[atropine]], as did [[heart block]], although cardiac pacing was also frequently utilized to treat heart block. Fluids and [[vasopressors ]]were used to maintain blood pressure, and in cases of [[cardiac failure]], [[inotropic ]]agents were administered. In addition, some patients received treatment with ventilatory support, gastric lavage, activated [[charcoal]], and/or intravenous calcium.
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| The effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose has been inconsistent. In a few reported cases, overdose with calcium channel blockers associated with [[hypotension ]]and [[bradycardia ]]that was initially refractory to atropine became more responsive to atropine after the patients received intravenous calcium. In some cases intravenous calcium has been administered (1 g [[calcium chloride]] or 3 g [[calcium gluconate]]) over 5 minutes and repeated every 10 to 20 minutes as necessary. [[Calcium gluconate]] has also been administered as a continuous infusion at a rate of 2 g per hour for 10 hours. Infusions of calcium for 24 hours or more may be required. Patients should be monitored for signs of [[hypercalcemia]].
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| In the event of overdose or exaggerated response, appropriate supportive measures should be employed in addition to gastrointestinal decontamination. Diltiazem does not appear to be removed by [[peritoneal dialysis|peritoneal ]]or [[hemodialysis]]. Limited data suggest that plasmapheresis or [[charcoal ]]hemoperfusion may hasten diltiazem elimination following overdose. Based on the known pharmacological effects of diltiazem and/or reported clinical experiences, the following measures may be considered:
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| '''Bradycardia:''' Administer [[atropine ]](0.60 to 1.0 mg). If there is no response to vagal blockade, administer [[isoproterenol ]]cautiously.
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| '''High-Degree AV Block:''' Treat as for [[bradycardia ]]above. Fixed high-degree [[AV block]] should be treated with cardiac pacing.
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| '''Cardiac Failure:''' Administer inotropic agents ([[isoproterenol]], [[dopamine]], or [[dobutamine]]) and diuretics.
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| '''Hypotension:''' Vasopressors (e.g., [[dopamine ]]or [[norepinephrine]]).
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| Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = CARDIZEM (DILTIAZEM HYDROCHLORIDE) TABLET, COATED [BTA PHARMACEUTICALS] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=461fe23f-4453-4e3f-9621-0e3fda057d14 | publisher = | date = | accessdate = 5 March 2014 }}</ref>
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| ==References==
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| {{Reflist|2}}
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| [[Category:Cardiovascular Drugs]]
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| [[Category:Drugs]]
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