Management of Amlodipine overdose: A multi modal approach
Keywords:
Calcium channel blocker poisoning, CCB poisoning, Amlodipine overdose, Amlodipine toxicity, HIET, High dose Insulin, Glucagon, Intra lipid emulsionAbstract
Background: Calcium channel blockers (CCB) are among the first line medications recommended for the treatment of hypertension with amlodipine being a common choice [1] . Amlodipine is a dihydropyridine CCB with a primary vasodilatory effect on vascular smooth muscle cells via inhibition of calcium influx through L-gated calcium channels in cardiac and vascular smooth muscle cells [2]. Amlodipine overdose typically manifests as vasodilatory shock associated with reflex sinus tachycardia, metabolic acidosis, hyperglycemia, and pulmonary edema [3]. In contrast, non-dihydropyridine CCB medications such as verapamil and diltiazem have more direct effects on cardiac conduction and AV nodal activity, so overdose presents as bradycardia and heart block [2] .
Among the cardiovascular drug overdose, the long-acting (30 -58 hours) Amlodipine overdose is very difficult to treat. They cause refractory hypotension demanding multi modal approach of critical treatment. Here we present a case of Amlodipine overdose, effectively managed in our ICU
