Ivabradine and atenolol overdose managed with renal replacement therapy: A case report

Ivabradine, an inhibitor of the sinoatrial pacemaker current, and atenolol, a cardioselective beta-blocker, are both used in the management of chronic systolic heart failure. While beta-blocker toxicity is well-documented, ivabradine poisoning is rare. This case report discusses the clinical course of a patient who presented with profound bradycardia and hypotension after ingesting large doses of ivabradine and atenolol. Toxicity was successfully managed with supportive care including atropine boluses and an epinephrine infusion. Renal replacement therapy (RRT) was employed to enhance atenolol elimination, yet serial drug levels revealed a significant reduction in ivabradine concentrations without a corresponding effect on atenolol levels. This case suggests a potential role for RRT in severe ivabradine poisoning and underscores the need for further research into optimal management strategies.