Treatment of serious calcium channel blocker overdose with levosimendan, a calcium sensitizer.
Calcium channel blocker (CCB) overdose is often lethal. Conventional medical treatment includes i.v. calcium, high doses of catecholamines, insulin, and glucagon. A new inotropic drug, levosimendan, should be considered in severe CCB poisoning. Levosimendan's pharmacologic features differ from other inotropic drugs. It is a calcium sensitizer and improves contraction without increasing intracytosolic calcium concentration. We describe two patients with serious CCB overdose. Despite intensive medical and mechanical cardiovascular support, both patients remained in shock. Hemodynamics gradually improved after administration of levosimendan.
Varpula
Tero
T
Department of Anesthesiology and Intensive Care Medicine, Jorvi Hospital, Turuntie 150, 02740 Espoo, Finland. tero.varpula@hus.fi
Rapola
Janne
J
Sallisalmi
Marko
M
Kurola
Jouni
J
D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced; D017311:Amlodipine / Q000506:poisoning; D002121:Calcium Channel Blockers / Q000506:poisoning*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003128:Coma / Q000139:chemically induced; D062787:Drug Overdose; D004452:Echocardiography; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000627:therapeutic use*; D012769:Shock / Q000139:chemically induced / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D000077464:Simendan; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014700:Verapamil / Q000506:poisoning
D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D014662:Vasoconstrictor Agents; D017311:Amlodipine; D000077464:Simendan; D014700:Verapamil; D004837:Epinephrine