CLINICAL PHARMACOLOGY 2003 (PART 25B)

Overdose, including self-poisoning, causes bradycardia, heart block, hypotension and low output cardiac failure that can proceed to cardiogenic shock; death is more likely with agents having membrane stabilising action (see Table 23.1). Bronchoconstriction can be severe, even fatal, in patients subject to any bronchospastic disease; loss of consciousness may occur with lipid-soluble agents that penetrate the central nervous system. Receptor blockade will outlast the persistence of the drug in the plasma. Rational treatment includes: • Atropine (1-2 mg i.v. as 1 or 2 bolus doses) to eliminate the unopposed vagal activity that contributes to bradycardia. Most patients will also...