pms-Carvedilol Overdosage

Cases of overdosage with carvedilol alone or in combination with other drugs have been reported. Quantities ingested in some cases exceeded 1000 mg. Clinical signs experienced included low blood pressure and heart rate. Standard supportive treatment was provided and individuals recovered.
In the event of inadvertent or intentional overdosage with carvedilol, there may be severe hypotension, excessive bradycardia, heart failure, cardiogenic shock, and cardiac arrest due to its pharmacologic activities. There may also be respiratory distress, bronchospasm, vomiting, disturbed consciousness, and generalized seizures.
Patients who have taken an overdose of carvedilol should be placed supine, with their legs raised. For removal of the drug shortly after ingestion, gastric lavage or pharmacologically induced emesis may be useful. Carvedilol is not removed by hemodialysis. In addition to these general procedures, the patient's vital signs should be monitored under intensive care conditions with continuous monitoring, if necessary.
The following additional supportive therapies can be used: If excessive hypotension occurs, vasopressors, norepinephrine or noradrenaline should be administered with continuous monitoring of the circulatory system. Digitalis, diuretics, and if necessary, dopamine or dobutamine should be administered if cardiac failure occurs.
For excessive bradycardia, atropine 0.5 to 2 mg should be given intravenously. In addition, glucagon 1 to 10 mg given intravenously over 30 seconds initially, followed by a continuous infusion of 2 to 2.5 mg/h, has been shown to be effective when severe overdosage of beta blockers causes hypotension and or bradycardia. For therapy-resistant bradycardia, pacemaker therapy may be necessary.
For bronchospasm, beta-sympathomimetics (as aerosol or intravenously) or intravenous aminophylline should be given.
In the event of seizures, slow intravenous injection of diazepam or clonazepam is recommended.
NOTE: In the event of severe intoxication where there are symptoms of shock, treatment must be continued for a sufficiently long period of time consistent with the 7 to 10 hour elimination half-life of carvedilol.
For management of a suspected drug overdose, contact the regional Poison Control Centre immediately.