{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:44Z","timestamp":1753876184999,"version":"3.41.2"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T00:00:00Z","timestamp":1711497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Amlodipine is the most commonly prescribed calcium channel blocker (CCB), used in the treatment of a variety of cardiovascular conditions. Calcium channel blockers remain a well-established cause of cardiovascular drug overdose. We present the case of an intentional overdose with 250 mg of amlodipine resulting in acute left ventricular dysfunction and myocarditis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 46-year-old man with no significant past medical history presented to the emergency department 8 h after intentionally ingesting 250 mg of amlodipine. Although initially asymptomatic with unremarkable physical examination, the patient developed progressively worsening dyspnoea over the next 2 days. Subsequent findings from chest X-ray, electrocardiogram, echocardiogram, and cardiac magnetic resonance imaging (MRI) were consistent with a diffuse myocarditis process with severe left ventricular systolic dysfunction. The patient was managed with diuretics and discharged once stable.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Our case highlights myocarditis as a potential complication of CCB overdose. Amlodipine is the most commonly prescribed CCB and is associated with cardiac toxicity at high doses. The long duration of action and high volume of distribution of amlodipine further increase the risk of morbidity and mortality from overdose. Known cardiac complications of amlodipine overdose include bradycardia, myocardial depression, and pulmonary oedema secondary to heart failure; however, diffuse myocarditis is a complication that has not previously been described in the literature. The mechanism of development of this complication remains unclear.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae161","type":"journal-article","created":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T19:53:54Z","timestamp":1711569234000},"source":"Crossref","is-referenced-by-count":3,"title":["Drug-induced myocarditis precipitated by amlodipine overdose: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0343-5399","authenticated-orcid":false,"given":"Maria","family":"Skaria","sequence":"first","affiliation":[{"name":"University of Birmingham \u00a0 Medical School, Vincent Drive, Edgbaston , Birmingham B15 2TT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Hoey","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Watkin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Binoy","family":"Skaria","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,3,27]]},"reference":[{"key":"2024043015373825700_ytae161-B1","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1080\/15563650.2022.2132768","article-title":"2021 annual report of the National Poison Data System \u00a9 (NPDS) from America\u2019s Poison Centers: 39th annual report","volume":"60","author":"Gummin","year":"2022","journal-title":"Clin Toxicol"},{"key":"2024043015373825700_ytae161-B2","first-page":"458","article-title":"Combination treatment of hypertension in 2015","volume":"61","author":"\u0160pinar","year":"2015","journal-title":"Vnitr Lek"},{"key":"2024043015373825700_ytae161-B3","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/j.1751-7176.2011.00513.x","article-title":"Calcium channel blockers","volume":"13","author":"Elliott","year":"2011","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"2024043015373825700_ytae161-B4","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2165\/00139709-200423040-00003","article-title":"Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity","volume":"23","author":"DeWitt","year":"2004","journal-title":"Toxicol Rev"},{"key":"2024043015373825700_ytae161-B5","doi-asserted-by":"crossref","first-page":"926","DOI":"10.3109\/15563650.2014.965827","article-title":"Treatment for calcium channel blocker poisoning: a systematic review","volume":"52","author":"St-Onge","year":"2014","journal-title":"Clin Toxicol (Phila)"},{"key":"2024043015373825700_ytae161-B6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.2165\/00003088-199222010-00003","article-title":"Clinical pharmacokinetics of amlodipine","volume":"22","author":"Meredith","year":"1992","journal-title":"Clin Pharmacokinet"},{"key":"2024043015373825700_ytae161-B7","doi-asserted-by":"crossref","first-page":"489","DOI":"10.4097\/kja.d.17.00071","article-title":"Amlodipine toxicity complicated by concurrent medications","volume":"71","author":"Gupta","year":"2018","journal-title":"Korean J Anesthesiol"},{"key":"2024043015373825700_ytae161-B8","doi-asserted-by":"crossref","first-page":"375","DOI":"10.4103\/0972-5229.123452","article-title":"Shock due to amlodipine overdose","volume":"17","author":"Upreti","year":"2013","journal-title":"Indian J Crit Care Med"},{"key":"2024043015373825700_ytae161-B9","first-page":"76","article-title":"Drug-induced toxic myocarditis","volume":"30","author":"Ansari","year":"2003","journal-title":"Tex Heart Inst J"},{"key":"2024043015373825700_ytae161-B10","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1001\/jama.2010.1343","article-title":"Effect of binge drinking on the heart as assessed by cardiac magnetic resonance imaging","volume":"304","author":"Zagrosek","year":"2010","journal-title":"JAMA"},{"key":"2024043015373825700_ytae161-B11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/15563650.2018.1497172","article-title":"Mechanisms of toxic cardiomyopathy","volume":"57","author":"Hantson","year":"2019","journal-title":"Clin Toxicol (Phila)"},{"key":"2024043015373825700_ytae161-B12","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4103\/0972-5229.45080","article-title":"Calcium channel blocker overdose: experience with amlodipine","volume":"12","author":"Ghosh","year":"2008","journal-title":"Indian J Crit Care Med"}],"container-title":["European Heart Journal - 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