Importance of early intervention in verapamil overdose – Case Report and antidotes review

Abstract

Introduction Verapamil is a widely used cardiac drug. It belongs to the non-dihydropiridine subgroup of calcium channel blockers (CCBs), and is used mainly for the treatment of atrial dysrhythmias, hypertension or angina. In this article, we describe a case of poisoning with verapamil mixed with ethanol and review current treatment options. A 54-year-old female was admitted to the Toxicology Clinic by emergency medical services after ingesting sustained-release CCBs and ethanol in a suicidal attempt. The patient was successfully treated by administration of catecholamines and calcium, and the introduction of a high-dose insulin infusion (HDI). Conclusions This case report emphasizes that even in severe poisoning, early and proper intervention may prevent circulatory breakdown. It also summarizes treatment options in patients after verapamil overdose. Along with decontamination, administration of catecholamines and correcting electrolyte abnormalities, the main options are HDI and lipid emulsion therapy (LET)

Keywords

• overdose
• calcium channel blocker
• high-dose insulin
• verapamil intoxication
• toxicology
• lipid emulsion therapy
• antidotes