title: Carvedilol overdose with quantitative confirmation.
abstract: Carvedilol is a non-selective beta-adrenoreceptor antagonist that is also an antagonist at the alpha(1)-adrenoreceptor. This unique pharmacological effect may produce a different toxicodynamic profile compared to other beta-adrenoreceptor antagonists. Only one previous case of carvedilol overdose has been reported. Here, we report massive carvedilol ingestion confirmed by quantitative analysis. The case report deals with an 84-year-old man who chewed a total of 60 (6.25 mg) tablets and rapidly developed symptoms. Vital signs on presentation were systolic blood pressure 70 mmHg; heart rate 45 beats/min.; respirations 18 breaths/min.; temperature 37 degrees . The electrocardiogram showed a junctional rhythm at 49 beats/min. The patient was treated with normal saline boluses, repeated glucagon boluses (2-3 mg each) and a dopamine infusion. At 14 hr after ingestion, he was weaned off vasopressors and was in a normal sinus rhythm. Quantitative confirmation showed a carvedilol serum concentration of 472 ng/ml (steady-state concentration 8.5 ng/ml during 6.25 mg twice daily dosing). Despite its unique pharmacological properties, the clinical manifestations of carvedilol overdose appear similar to other beta-adrenoreceptor antagonists.
authors.affiliation: New York City Poison Control Center; and Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA. nb2233@columbia.edu
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Bouchard
authors.forename: Jenice
authors.initials: J
authors.lastname: Forde
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000506:poisoning*; D000319:Adrenergic beta-Antagonists / Q000506:poisoning*; D000369:Aged, 80 and over; D002227:Carbazoles / Q000506:poisoning*; D000077261:Carvedilol; D004298:Dopamine / Q000627:therapeutic use; D062787:Drug Overdose; D005934:Glucagon / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011412:Propanolamines / Q000506:poisoning*
chemical_list: D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D005934:Glucagon; D004298:Dopamine