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Carvedilol overdose with quantitative confirmation.

Nicole C Bouchard¹, Jenice Forde, Robert S Hoffman

¹New York City Poison Control Center; and Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA. nb2233@columbia.edu

Basic & Clinical Pharmacology & Toxicology

|July 5, 2008

Summary

This summary is machine-generated.

Massive carvedilol overdose in an elderly patient presented with bradycardia and hypotension. Despite unique pharmacology, clinical effects mimicked other beta-blocker overdoses, with recovery after glucagon and vasopressor support.

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Area of Science:

Pharmacology
Toxicology
Cardiology

Background:

Carvedilol, a non-selective beta-adrenoreceptor antagonist with alpha(1)-adrenoreceptor antagonism, possesses a unique profile.
Overdose cases are rare, with only one prior report of carvedilol overdose.

Observation:

An 84-year-old male ingested 375 mg (60 tablets of 6.25 mg) of carvedilol.
Presentation included severe bradycardia (45 bpm), hypotension (SBP 70 mmHg), and junctional rhythm.
Quantitative analysis confirmed a significantly elevated serum carvedilol concentration of 472 ng/ml.

Findings:

The patient was successfully treated with intravenous fluids, glucagon boluses, and dopamine infusion.
Recovery included normalization of heart rhythm to sinus rhythm and discontinuation of vasopressors within 14 hours.
Despite its dual receptor antagonism, carvedilol overdose manifestations were similar to other beta-adrenoreceptor antagonist overdoses.

Implications:

This case highlights the potential for severe toxicity with massive carvedilol ingestion.
Glucagon and vasopressors are effective in managing carvedilol-induced cardiovascular collapse.
The toxicodynamic profile of carvedilol overdose aligns with that of other beta-blockers, despite its unique alpha-blocking properties.