Glucagon is Out for Calcium Channel Blocker Overdose

Today’s pearl is about management of calcium channel blocker poisoning .

Glucagon was an option in the past, but is no longer recommended due to lack of supporting data and risk of adverse effects.

• Expert consensus guidelines were recently published (St-Onge 2017).

  • First-line therapies include IV calcium, vasopressors, and high-dose insulin euglycemic therapy.

• Patients may have other potential causes for toxin-induced cardiovascular shock (eg, also on beta blockers).

• In these cases, where beta-blockers are a possible contributing cause, it still makes sense to try a bolus of glucagon (5 mg).  An infusion should only be started if a patient’s hemodynamics respond favorably to this bolus.

  • Prepare for vomiting and pre-treat with an antiemetic (i.e., ondansetron).

^#5

Author: Bryan D. Hayes, PharmD

Attending Pharmacist, Emergency Medicine and Toxicology, Massachusetts General Hospital; Assistant Professor of EM, Harvard Medical School View all posts by Bryan D. Hayes, PharmD