{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:26:42Z","timestamp":1792661202154,"version":"4.5.0"},"reference-count":54,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,10,30]],"date-time":"2015-10-30T00:00:00Z","timestamp":1446163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:p>Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta\u2010adrenergic receptor antagonist (BB) poisoning follows similar principles. Significant myocardial depression, bradycardia and hypotension result in both cases. CCBs can also produce vasodilatory shock. Additionally, CCBs, such as verapamil and diltiazem, are commonly ingested in sustained\u2010release formulations. This can also be the case for some BBs. Peak toxicity can be delayed by several hours. Provision of early gastrointestinal decontamination with activated charcoal and whole\u2010bowel irrigation might mitigate this. Treatment of shock requires a multimodal approach to inotropic therapy that can be guided by echocardiographic or invasive haemodynamic assessment of myocardial function. High\u2010dose insulin euglycaemia is commonly recommended as a first\u2010line treatment in these poisonings, to improve myocardial contractility, and should be instituted early when myocardial dysfunction is suspected. Catecholamine infusions are complementary to this therapy for both inotropic and chronotropic support. Catecholamine vasopressors and vasopressin are used in the treatment of vasodilatory shock. Optimizing serum calcium concentration can confer some benefit to improving myocardial function and vascular tone after CCB poisoning. High\u2010dose glucagon infusions have provided moderate chronotropic and inotropic benefits in BB poisoning. Phosphodiesterase inhibitors and levosimendan have positive inotropic effects but also produce peripheral vasodilation, which can limit blood pressure improvement. In cases of severe cardiogenic shock and\/or cardiac arrest post\u2010poisoning, extracorporeal cardiac assist devices have resulted in successful recovery. Other treatments used in refractory hypotension include intravenous lipid emulsion for lipophilic CCB and BB poisoning and methylene blue for refractory vasodilatory shock.<\/jats:p>","DOI":"10.1111\/bcp.12763","type":"journal-article","created":{"date-parts":[[2015,9,7]],"date-time":"2015-09-07T22:31:32Z","timestamp":1441665092000},"page":"453-461","source":"Crossref","is-referenced-by-count":129,"title":["Calcium channel antagonist and beta\u2010blocker overdose: antidotes and adjunct therapies"],"prefix":"10.1111","volume":"81","author":[{"given":"Andis","family":"Graudins","sequence":"first","affiliation":[{"name":"Monash Health Clinical Toxicology and Addiction Medicine Service, Monash Health Dandenong Hospital  David Street Dandenong VIC 3175 Australia"},{"name":"Monash Emergency Program, Monash Health Dandenong Hospital  David Street Dandenong VIC 3175 Australia"},{"name":"School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences Monash 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