Verapamil poisoning with

Link A, Hammer B, Weisgerber K, Bohm M. Therapie der Verapamil-Intoxikation mit Noradrenahn und dem Phosphodiesterasehemmer Enoximon. [Therapy of verapamil poisoning with noradrenaline and the phosphodiesterase inhibitor enoximone.] Dtsch Med Wochenschr 2002 127(39) 2006-8. 

The treatment of overdosage with calcium channel blockers has been reviewed (141) other reports have reviewed poisoning with verapamil (142-144), and other calcium channel blockers (145,146). 

Perkins CM. Serious verapamil poisoning treatment with intravenous calcium gluconate. BMJ 1978 2(6145) 1127. 

Verapamil poisoning can cause cardiac toxicity with cardiogenic shock, conduction abnormahties (including hfe-threatening dysrhythmias), hypotension, and death. 

Enoximone has been used to treat cardiogenic shock in a case of self-poisoning with verapamil 2.4 g in a 40-year-old woman treatment with calcium and noradrenaline had been unsuccessful (22). 

Severe poisoning with modified-release verapamil was associated with respiratory failure in a 27-year-old man, who presented 2 hours after taking 24 g, one of the largest reported overdoses (24). He snrvived after receiving 4 days of partial liquid ventilation as a part of his medical management. 

Treat coma (see p 19), hypotension (p 16), and bradyarrhythmias (p 10) if they occur. The use of cardiopulmonary bypass to allow time for liver metabolism has been reported In a patient with massive verapamil poisoning. Cardiac pacing should be considered for bradyarrhythmias that are contributing to hypotension. 

Pearigen PD, Benowitz NL. Poisoning due to calcium antagonists. Experience with verapamil, diltiazem and nifedipine. Drug Saf 1991 6(6) 408-30. 

---