Antihypertensive poisoning
Calcium channel blocker and beta-blocker poisoning (verapamil and diltiazem vs dihydropyridines, propranolol and sotalol), echo-guided choice between vasopressors and high-dose insulin, calcium, glucagon, pacing, ECMO, the EXTRIP dialysis advice, and clonidine, prazosin and RAS blocker overdose.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Calcium channel blockers (CCBs) and beta-blockers cause most deaths from cardiovascular drug poisoning. Other antihypertensives are much less dangerous alone.
- The key question at the bedside: is this vasoplegia (warm, vasodilated, often tachycardic) or cardiogenic shock (bradycardia, poor contractility)? A bedside echo answers it and directs treatment.
- Verapamil and diltiazem cause both. Dihydropyridines (amlodipine, felodipine, lercanidipine, nifedipine) mainly cause vasoplegia.
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Sources
- Therapeutic Guidelines: Toxicology and Toxinology (December 2024 update, including EXTRIP-based haemodialysis advice for beta-blockers and revised clonidine and guanfacine advice)AU/NZTherapeutic Guidelines Limited, 2024
- Isoardi KZ, Chan B, Chiew AL. High dose insulin is an inodilator, not an antidote in the poisoned patient! Emerg Med Australas 2025;37:e70035AU/NZEmergency Medicine Australasia, 2025
- Chan BSH, Isoardi KZ, Roberts DM, Har OS. Management of hypotension in dihydropyridine calcium channel blocker overdose: the role of high-dose insulin therapy. Br J Clin Pharmacol 2025;91:2613-20AU/NZBritish Journal of Clinical Pharmacology, 2025
- St-Onge M, Anseeuw K, Cantrell FL et al. Experts consensus recommendations for the management of calcium channel blocker poisoning in adults. Crit Care Med 2017;45:e306-15Critical Care Medicine, 2017
- Wong A, Hoffman RS, Walsh SJ et al. Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol 2021;59:361-75Clinical Toxicology, 2021
- Bouchard J, Shepherd G, Hoffman RS et al. Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup. Crit Care 2021;25:201Critical Care, 2021
- Hoegberg LCG, Gosselin S, Buckley NA et al. Recommendations from the Clinical Toxicology Recommendations Collaborative on the administration of activated charcoal in acute oral overdose. Clin Toxicol 2026;64:419-75Clinical Toxicology, 2026
- Gosselin S, Hoegberg LC, Hoffman RS et al. Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning. Clin Toxicol 2016;54:899-923Clinical Toxicology, 2016
- Lal OBE, Buckley NA, Cairns R. Self-poisoning with prazosin and its off-label use in Australia, 2014-2024: analysis of NSW Poisons Information Centre data. Med J Aust 2026;224:e70242AU/NZMedical Journal of Australia, 2026
- Last updated
- 14 November 2026
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