Diltiazem hydrochloride tablet overdosage: Difference between revisions
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==OVERDOSAGE== | |||
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. | |||
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. | |||
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. | |||
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. | |||
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]]. | |||
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: | |||
'''Bradycardia:''' Administer [[atropine ]](0.60 to 1.0 mg). If there is no response to vagal blockade, administer [[isoproterenol ]]cautiously. | |||
'''High-Degree AV Block:''' Treat as for [[bradycardia ]]above. Fixed high-degree [[AV block]] should be treated with cardiac pacing. | |||
'''Cardiac Failure:''' Administer inotropic agents ([[isoproterenol]], [[dopamine]], or [[dobutamine]]) and diuretics. | |||
'''Hypotension:''' Vasopressors (e.g., [[dopamine ]]or [[norepinephrine]]). | |||
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> | <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> | ||
Revision as of 16:26, 5 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
OVERDOSAGE
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.
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.
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.
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.
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.
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 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:
Bradycardia: Administer atropine (0.60 to 1.0 mg). If there is no response to vagal blockade, administer isoproterenol cautiously.
High-Degree AV Block: Treat as for bradycardia above. Fixed high-degree AV block should be treated with cardiac pacing.
Cardiac Failure: Administer inotropic agents (isoproterenol, dopamine, or dobutamine) and diuretics.
Hypotension: Vasopressors (e.g., dopamine or norepinephrine).
Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician.
References
- ↑ "CARDIZEM (DILTIAZEM HYDROCHLORIDE) TABLET, COATED [BTA PHARMACEUTICALS]". Retrieved 5 March 2014.