Journal of Multidisciplinary Healthcare (Aug 2022)

Calcium Channel Blocker Toxicity: A Practical Approach

  • Alshaya OA,
  • Alhamed A,
  • Althewaibi S,
  • Fetyani L,
  • Alshehri S,
  • Alnashmi F,
  • Alharbi S,
  • Alrashed M,
  • Alqifari SF,
  • Alshaya AI

Journal volume & issue
Vol. Volume 15
pp. 1851 – 1862

Abstract

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Omar A Alshaya,1– 3 Arwa Alhamed,3,4 Sara Althewaibi,1 Lolwa Fetyani,1 Shaden Alshehri,1 Fai Alnashmi,1 Shmeylan Alharbi,1– 3 Mohammed Alrashed,1– 3,5 Saleh F Alqifari,6 Abdulrahman I Alshaya1– 3 1Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Pharmacy Department, Northwest Medical Center, Tucson, AZ, USA; 6Department of Pharmacy Practice, College of Pharmacy, University of Tabuk, Tabuk, Saudi ArabiaCorrespondence: Omar A Alshaya, Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481, Saudi Arabia, Email [email protected]: Calcium channel blockers (CCBs) are widely prescribed medications for various clinical indications in adults and children. They are available in both immediate and long-acting formulations and are generally classified into dihydropyridines and nondihydropyridines, with nondihydropyridines having more cardioselectivity. CCB toxicity is common given the widespread use which leads to serious adverse clinical outcomes, especially in children. Severe CCB toxicities may present with life-threatening bradycardia, hypotension, hyperglycemia, and renal insufficiency. Dihydropyridine toxicity, however, may present with reflex tachycardia instead of bradycardia. Initial patient evaluation and assessment are crucial to identify the severity of CCB toxicity and design the best management strategy. There are different strategies to overcome CCB toxicity that requires precise dosing and close monitoring in various patient populations. These strategies may include large volumes of IV fluids, calcium salts, high insulin euglycemia therapy (HIET), and vasopressors. We hereby summarize the evidence behind the management of CCB toxicity and present a practical guide for clinicians to overcome this common drug toxicity.Keywords: calcium channel blockers, drug overdose, poisoning, emergency medicine, toxicity

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