Sign Out
Toxicity: Felodipine: 10 mg in a 2-year-old caused mild intoxication. 150-200 mg in a 17-year-old and 250 mg in an adult caused mild to moderate intoxication. Probably a more pronounced effect on the peripheral circulation than on the heart, compared with other drugs in the group.
Metoprolol: 7.5 g in an adult caused fatal intoxication. 100 mg in a 5-year-old caused no symptoms after gastric lavage. 450 mg in a 12-year-old and 1.4 g in an adult caused moderate intoxication, 2.5 g in an adult caused severe intoxication, 7.5 g in an adult caused very severe intoxication.
Symptoms: In cases of intoxication with prolonged release preparations the onset of symptoms may be delayed for 12-16 hours, and severe symptoms may occur after several days.
Felodipine: The effect on the circulation constitutes the greatest risk: bradycardia (sometimes tachycardia), fall in blood pressure. AV block I-III, AV dissociation, VES, ventricular fibrillation, asystole. Dizziness, headache, impaired consciousness, coma, convulsions. Dyspnea, pulmonary edema (non-cardiac) and apnea. Possibly ARDS (Adult Respiratory Distress Syndrome). Acidosis, hypokalemia, hyperglycemia, possibly hypocalcemia. Flushing, hypothermia. Nausea and vomiting.
Metoprolol: Cardiovascular symptoms the most important, but in some cases, especially in children and adolescents, CNS symptoms and respiratory depression may predominate. Bradycardia. AV block I-III, asystole, fall in blood pressure, poor peripheral blood perfusion, cardiac incompensation, cardiogenic shock. Respiratory depression, apnea. Other: Fatigue, muzziness, unconsciousness, fine tremor, convulsions, sweating, paresthesia, bronchospasm, nausea, vomiting, possibly esophageal spasm, hypoglycemia (especially in children), or hyperglycemia, hyperkalemia. Effect on the kidneys. Transient myasthenic syndrome. Concomitant ingestion of alcohol, antihypertensive drugs, quinidine or barbiturates can aggravate the patient's condition. The first signs of overdose may be seen 20 minutes to 2 hours after ingestion.
Treatment: Felodipine: Charcoal, if necessary gastric lavage, in some cases even at a late stage. NOTE! Atropine (0.25-0.5 mg intravenously for adults, 10-20 micrograms/kg for children) should be given before gastric lavage (on account of the risk of vagal stimulation). ECG monitoring. Respirator treatment if indicated. Correction of acid-base and electrolyte status. In cases of bradycardia and block: Atropine 0.5-1 mg intravenously for adults (20-50 micrograms/kg for children), possibly repeated, or isoprenaline initially 0.05-0.1 micrograms/kg/minute. Pacemaker at an early stage in severe cases. In cases of hypotension: intravenous fluid, calcium glubionate (9 mg Ca/mL) 20(-30) mL intravenously over a period of 5 minutes for adults (3-5 mg Ca/kg for children) initially and repeated if required, or as an infusion, adrenaline or dopamine if required. In severe cases glucagon may be tried. In cases of circulatory arrest in connection with overdose, attempts at resuscitation for several hours may be necessary. Diazepam for convulsions. Other symptomatic treatment.
Metoprolol: Charcoal, gastric lavage if required. NOTE! Atropine (0.25-0.5 mg intravenously for adults, 10-20 micrograms/kg for children) should be given before gastric lavage (on account of the risk of vagal stimulation). Intubation and respirator treatment should be carried out if indicated. Adequate volume expansion. Glucose infusion. ECG monitoring. Atropine 1.0-2.0 mg intravenously, possibly repeated (especially in cases of vagal symptoms). For myocardial depression: infusion of dobutamine or dopamine and calcium glubionate 9 mg/mL, 10-20 mL. Glucagon 50-150 micrograms/kg intravenously over a period of 1 minute followed by infusion may also be tried, as can amrinone. In some cases the addition of epinephrine (adrenaline) has been effective. Infusion of sodium (chloride or bicarbonate) in cases of widening QRS-complex and arrhythmias. Possibly pacemaker. In cases of circulatory arrest in connection with overdose resuscitation measures for several hours may be necessary. For bronchospasm possibly terbutaline (via injection or inhalation). Symptomatic therapy
