Isbister Geoffrey K, Jenkins Shane, Harris Keith, Downes Michael A, Isoardi Katherine Z
Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia.
Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, Australia.
Br J Clin Pharmacol. 2025 Mar;91(3):740-747. doi: 10.1111/bcp.16258. Epub 2024 Sep 21.
Calcium channel blocker (CCB) overdose remains an important poisoning, with increasing availability of dihydropyridines. We aimed to compare the severity and treatment of CCB overdoses.
We reviewed CCB overdoses presenting to two toxicology services from 2014 to 2023. We extracted prospectively collected data from a clinical database, including demographics, dose, co-ingestants, complications, treatments and outcomes, to compare different CCBs.
There were 236 overdoses; median age 55 years (interquartile range [IQR]: 41-65 years); 130 (55%) were females. Dihydropyridine overdoses increased significantly: median of nine cases annually (IQR: 8.8-12.3) during the study compared to a median of three cases annually (IQR: 1-4.3; P < 0.001) in the 10 years prior. The commonest agent was amlodipine (147), then lercanidipine (28), diltiazem (27), verapamil (23) and felodipine (11). Median defined daily dose ingested was higher for dihydropyridines, and cardiac co-ingestants were common except verapamil. Median length of stay was 21 h (IQR: 13-43 h), which was similar except longer for diltiazem (median, 39 h). Fifty-six patients (24%) were admitted to intensive care, more often for diltiazem (14; 52%) and verapamil (7; 30%). Dysrhythmias occurred in 19 patients (diltiazem [9], verapamil [8], amlodipine [2]), and included 13 junctional dysrhythmias. Hypotension occurred in 91 patients (39%), 62 (26%) received inotropes/vasopressors (adrenaline 32 [52%], noradrenaline 48 [77%]), 21 (9%) high-dose insulin and 44 (19%) calcium. Adrenaline and high-dose insulin were more commonly given in diltiazem and verapamil overdoses, compared to vasopressors in dihydropyridine overdoses. Acute kidney injury occurred in 39 patients. Seven (3%) patients died.
Dihydropyridines were the commonest CCB overdoses, with amlodipine making up half. More severe toxicity occurred with diltiazem and verapamil.
随着二氢吡啶类药物的可及性增加，钙通道阻滞剂（CCB）过量服用仍是一种重要的中毒情况。我们旨在比较CCB过量服用的严重程度及治疗方法。
我们回顾了2014年至2023年期间向两个毒理学服务机构就诊的CCB过量服用病例。我们从临床数据库中提取了前瞻性收集的数据，包括人口统计学信息、剂量、合并摄入的物质、并发症、治疗方法及结果，以比较不同的CCB。
共有236例过量服用病例；中位年龄55岁（四分位间距[IQR]：41 - 65岁）；130例（55%）为女性。二氢吡啶类药物过量服用病例显著增加：研究期间每年中位病例数为9例（IQR：8.8 - 12.3），而之前10年每年中位病例数为3例（IQR：1 - 4.3；P < 0.001）。最常见的药物是氨氯地平（147例），其次是乐卡地平（28例）、地尔硫䓬（27例）、维拉帕米（23例）和非洛地平（11例）。二氢吡啶类药物摄入的中位限定日剂量更高，除维拉帕米外，合并摄入心脏类药物很常见。中位住院时间为21小时（IQR：13 - 43小时），除地尔硫䓬（中位39小时）外，其他药物的住院时间相似。56例患者（24%）入住重症监护病房，地尔硫䓬（14例；52%）和维拉帕米（7例；30%）患者入住重症监护病房的情况更常见。19例患者出现心律失常（地尔硫䓬[9例]、维拉帕米[8例]、氨氯地平[2例]），其中包括13例交界性心律失常。91例患者（39%）出现低血压，62例（26%）接受了血管活性药物治疗（肾上腺素32例[52%]、去甲肾上腺素48例[77%]），21例（9%）接受了高剂量胰岛素治疗，44例（19%）接受了钙剂治疗。与二氢吡啶类药物过量服用时使用血管活性药物相比，地尔硫䓬和维拉帕米过量服用时更常使用肾上腺素和高剂量胰岛素。39例患者发生急性肾损伤。7例（3%）患者死亡。
二氢吡啶类药物是最常见的CCB过量服用类型，氨氯地平占一半。地尔硫䓬和维拉帕米的毒性更严重。
