CCB overdose

Q: Hemodialysis should be instituted as early as possible in a Calcium Channel Blocker (CCB) overdose.

A) True

B) False

Answer: B

CCBs are highly protein-bound, so extracorporeal removal via hemodialysis or Continuous Renal Replacement Therapy (CRRT) is usually not effective. Said that it may help in case acute kidney injury or severe acidosis ensues, it can be added as an adjuvant therapy. Extracorporeal membrane oxygenation (ECMO) should be considered early if standard-of-care therapies show no evidence of effectiveness. 

Major components of CCB overdose are:

• Atropine for symptomatic bradycardia
• Intravenous calcium
• Calcium infusion with close monitoring of ionized calcium.
• Glucagon 
• Vasopressors (norepinephrine is preferred)
• Insulin and glucose with monitoring of possible hypokalemia
• Methylene blue 
• High-dose cyanocobalamin

# toxicity

References:

1. Wong A, Hoffman RS, Walsh SJ, et al. Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol (Phila) 2021; 59:361.

2. Slamowitz A, Sweberg T, Labgold K, Nickerson T. Extracorporeal Membrane Oxygenation for Calcium Channel Blocker Intoxication: A Multicenter Retrospective Registry Review. ASAIO J. 2025 Oct 31. doi: 10.1097/MAT.0000000000002593. Epub ahead of print. PMID: 41168146.

3. Saha BK, Bonnier A, Chong W. Rapid reversal of vasoplegia with methylene blue in calcium channel blocker poisoning. Afr J Emerg Med 2020; 10:284.