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Severe carvedilol toxicity without overdose - caution in cirrhosis

Satish Maharaj1, Karan Seegobin1, Julio Perez-Downes1

  • 1Department of Internal Medicine, University of Florida College of Medicine, 4th Fl. LRC Building, 653 W 8th St, Jacksonville, Fl 32209 USA.

Clinical Hypertension
|December 8, 2017
PubMed

Insights

Patients with cirrhosis may experience carvedilol toxicity even at standard doses. Early recognition of this beta blocker toxicity and prompt treatment with glucagon are crucial for improved outcomes in this at-risk population.

Area of Science:

  • Cardiology
  • Hepatology
  • Clinical Pharmacology

Background:

  • Carvedilol is increasingly prescribed for portal hypertension in patients with cirrhosis.
  • Despite hepatic metabolism, no specific dosage adjustments exist for mild to moderate hepatic impairment.
  • Carvedilol offers improved outcomes in variceal bleeding and hepatic decompensation compared to other treatments.

Observation:

  • A case of cardiogenic shock occurred in a patient with cirrhosis after a 25 mg oral dose of carvedilol.
  • The event was diagnosed as carvedilol toxicity based on clinical toxidrome recognition, not overdose.
  • The patient recovered after treatment with a glucagon bolus and infusion.

Findings:

  • Patients with cirrhosis are a high-risk group for beta blocker toxicity.
  • The standard carvedilol toxicity threshold of 50 mg is not applicable to patients with cirrhosis.
  • Glucagon is an effective antidote for carvedilol-induced toxicity.

Implications:

  • Healthcare providers must recognize the clinical toxidrome of carvedilol toxicity in cirrhotic patients.
  • Hospitals should ensure glucagon is available for treating carvedilol toxicity in this population.
  • Dose adjustment and slow titration of carvedilol are recommended for patients with cirrhosis.
Abstract

Keywords:
Beta blockerCarvedilolCirrhosisGlucagonToxicityTreatment

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