Stanek E J, Nelson C E, DeNofrio D
Department of Pharmacy Practice Philadelphia College of Pharmacy and Science, PA 19104, USA.
Ann Pharmacother. 1997 Jul-Aug;31(7-8):853-6. doi: 10.1177/106002809703100708.
To report a nonfatal intentional overdose of amlodipine.
A 42-year-old woman with a history of hypertension reported ingesting 50-100 mg amlodipine besylate and at least 40 ounces of beer in a suicide attempt. The patient's symptoms were mild; BP ranged from 79/50 to 113/76 mm Hg and HR from 92 to 129 beats/min (sinus tachycardia). Laboratory studies revealed normoglycemia, mild metabolic acidosis, mild hypocalcemia, blood ethanol concentration of 263 mmol/L, and a serum amlodipine concentration of 88 ng/mL (normal 3-11) 2.5 hours after ingestion. Therapy included activated charcoal, whole bowel irrigation, and intravenous NaCl 0.9%. After receiving 1.5 L of NaCl 0.9%, the patient developed signs of mild pulmonary edema that resolved over several hours without intervention. A serum amlodipine concentration obtained 35 hours later was 79 mg/mL. The patient was discharged on day 2 in good condition.
In this case, an amlodipine overdose was associated with sustained hypotension and sinus tachycardia, as well as transient pulmonary edema following relatively low-volume fluid replacement. A previously published report described an amlodipine overdose that was fatal due to refractory hypotension and was complicated by concomitant oxazepam overdose.
Amlodipine overdose produces prolonged hemodynamic effects and may lead to pulmonary edema. Due to a long elimination half-life and delayed onset of effects, patients with amlodipine overdose should receive aggressive decontamination therapy and may require extended clinical monitoring and supportive care if they are hemodynamically unstable.
报告一例非致命性氨氯地平故意过量服用病例。
一名有高血压病史的42岁女性报告称，为自杀而服用了50 - 100毫克苯磺酸氨氯地平，并饮用了至少40盎司啤酒。患者症状较轻；血压范围为79/50至113/76毫米汞柱，心率为92至129次/分钟（窦性心动过速）。实验室检查显示血糖正常、轻度代谢性酸中毒、轻度低钙血症、血液乙醇浓度为263毫摩尔/升，摄入后2.5小时血清氨氯地平浓度为88纳克/毫升（正常范围3 - 11）。治疗措施包括活性炭、全肠道灌洗和静脉输注0.9%氯化钠溶液。在输注1.5升0.9%氯化钠溶液后，患者出现轻度肺水肿体征，数小时后未经干预自行消退。35小时后测得的血清氨氯地平浓度为79毫克/毫升。患者于第2天状况良好出院。
在该病例中，氨氯地平过量服用与持续性低血压和窦性心动过速相关，以及在相对少量补液后出现短暂性肺水肿。先前发表的一份报告描述了一例因难治性低血压导致致命的氨氯地平过量服用病例，且伴有奥沙西泮过量服用并发症。
氨氯地平过量服用会产生持久的血流动力学影响，并可能导致肺水肿。由于消除半衰期长且起效延迟，氨氯地平过量服用的患者应接受积极的去污治疗，若血流动力学不稳定，可能需要延长临床监测和支持性护理。
