Pharmacology and Review of Evidence


  1. Myocardial depression, bradycardia, and hypotension result from both CCB and BB toxicity

  2. Management of hemodynamic instability resulting from toxicity of CCBs and/or BBs follows similar principles

  3. GI decontamination may be warranted for patients who have ingested significant amounts of BB or CCB

  4. Initial management options include glucagon, high-dose insulin, calcium, and catecholamines with betaadrenergic activity

  5. Symptoms should occur within 6 hours post-ingestion, with the exception of sotalol and extended release formulations

Pharmacology and Review of Evidence


  1. Evidence for CCB and BB toxicity is increasing but still limited to case reports and case series

  2. In the setting of toxic CCB and/or BB ingestions, there are a variety of therapeutic modalities available

  3. Treatment may require combined use of the agents described above

  4. Contact your regional poison center: 1-800-222-1222


1. Kerns II W, et al. Insulin improves survival in a canine model of acute beta-blocker toxicity. Ann Emerg Med . 1997;29:748–757.

2. Holger JS, et al. Insulin versus vasopressin and epinephrine to treat beta-blocker toxicity. Clin Toxicol 2007;45:396–401.

3. Holger JS, et al. High-dose insulin: a consecutive case series in toxin-induced cardiogenic shock. Clin Toxicol. 2011;49:653–658.

4. Page C, et al. The use of high-dose insulin-glucose euglycemia in beta-blocker overdose: a case report. J Med Toxicol . 2009;5:139–143.

5. Stellpflug SJ, et al. Intentional overdose with cardiac arrest treated with intravenous fat emulsion and high-dose insulin. Clin Toxicol. 2010;48:227–229.

6. Engebretsen KM, et al. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol . 2011;49:277–283.

7. Love JN, et al. A potential role for glucagon in the treatment of drug-induced symptomatic bradycardia. Chest. 1998;114:323–326.

8. Kerns II, W., 2007. Management of β-adrenergic blocker and calcium channel antagonist toxicity. Emergency medicine clinics of North America, 25(2), pp.309-331. 9.

9. Doepker B, Healy W, Cortez E, Adkins EJ. High-dose insulin and intravenous lipid emulsion therapy for cardiogenic shock induced by intentional calcium-channel blocker and beta-blocker overdose: a case series. The Journal of emergency medicine. 2014 Apr 1;46(4):486-90.

10. Meany CJ, Sare H, Hayes BD, Gonzales JP. Intravenous lipid emulsion in the management of amlodipine overdose. Hosp Pharm. 2013:48(10):848-54.

11. Lashari BH, Minalyan A, Khan W, Naglak M, Ward W. The use of high-dose insulin infusion and lipid emulsion therapy in concurrent beta-blocker and calcium channel blocker overdose. Cureus 10(11):e3534. DOI 10.7759/cureus.3534

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