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Tarka® (trandolapril/verapamil hydrochloride extended-release) overdose
Victor Cohen1, Samantha P Jellinek, Lydia Fancher
1Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York 11219, USA.
The Journal of Emergency Medicine
|March 3, 2009
Summary
Overdosing on fixed-dose combination antihypertensives like verapamil and trandolapril requires careful toxicological management. Concurrent treatment of both calcium channel blocker and angiotensin-converting enzyme inhibitor components is crucial for patient stabilization.
Area of Science:
- Toxicology
- Cardiology
- Pharmacology
Background:
- Fixed-dose combination antihypertensives present unique overdose challenges.
- Verapamil and trandolapril combination toxicity requires tailored management.
- Angiotensin-converting enzyme inhibitor component can complicate calcium channel blocker overdose treatment.
Observation:
- A 60-year-old male ingested five tablets of verapamil and trandolapril combination.
- Patient presented with hypotension and bradycardia eight hours post-ingestion.
- Standard calcium channel blocker toxicity protocols were initiated.
Findings:
- Patient stabilization required dopamine titration in addition to standard therapies.
- Glucagon administration induced vomiting, contributing to stabilization.
- Full recovery was achieved within 40 hours post-ingestion.
Implications:
- Lack of familiarity with combination products hinders overdose management.
- Prompt recognition and concurrent treatment are vital for resuscitation.
- This case highlights the need for specific protocols for combination antihypertensive overdoses.
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