medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-42-8-14medalphabet-2397Research ArticleНЕОТЛОЖНАЯ МЕДИЦИНАEMERGENCY MEDICINEКардиотоксичность гипотензивных препаратов (обзор литературы). Часть II. Ингибиторы ангиотензинпревращающего фермента и смешанная  лекарственная передозировкаCardiotoxicity with antihypertensive drugs (literature review). Part II. Angiotensin converting enzyme inhibitors and multi-drug intoxicationhttps://orcid.org/0000-0003-0718-5258МоисееваА. Ю.MoiseyevaA. Yu.

Моисеева Александра Юрьевна, аспирант

Москва

Moiseyeva Alexandra Yu., postgraduate student

Moscow

moiseyeva.alexandra.y@yandex.ruhttps://orcid.org/0000-0002-4940-9574ЭсауленкоЭ. Н.EsaulenkoA. N.

Эсауленко Анна Николаевна, врач-кардиолог

Москва

Esaulenko Anna N., cardiologist

Moscow

aesaulenko95@mail.ruhttps://orcid.org/0000-0002-9738-1801ИванниковА. А.IvannikovA. A.

Иванников Александр Александрович, аспирант

Москва

Ivannikov Alexander A., postgraduate student

Moscow

ivannikov_a95@mail.ruhttps://orcid.org/0000-0002-1050-1867БратищевИ. В.BratischevI. V.

Братищев Игорь Викторович, врач – анестезиолог-реаниматолог, зав. учебным центром

Bratishchev Igor V., physician – anesthesiologist-resuscitator, head of Training Centre

Moscow

bratischev@mail.ruАлиджановаХ. Г.AlidzhanovaKh. G.

Алиджанова Хафиза Гафуровна, д. м. н., ст. преподаватель учебного отдела

 

Alijanova Khafiza G., DM Sci (habil.), senior lecturer of Educational Dept

Moscow

doctorhafiza@mail.ruФГАОУ ВО «Российский университет дружбы народов»РоссияPeoples' Friendship University of RussiaRussian FederationГБУЗ «Городская клиническая больница имени В. П. Демихова»РоссияV. P. Demikhov City Clinical HospitalRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет имени И. М. Сеченова» Минздрава России (Сеченовский университет)РоссияI. M. Sechenov First Moscow State Medical UniversityRussian FederationГБУЗ «Научно-исследовательский институт скорой помощи имени Н. В. Склифосовского Департамента здравоохранения Москвы»РоссияN. V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation202127122021042Кардиология. Неотложная медицина (4)814Copyright © Моисеева А.Ю., Эсауленко Э.Н., Иванников А.А., Братищев И.В., Алиджанова Х.Г., 20212021Моисеева А.Ю., Эсауленко Э.Н., Иванников А.А., Братищев И.В., Алиджанова Х.Г.Moiseyeva A.Y., Esaulenko A.N., Ivannikov A.A., Bratischev I.V., Alidzhanova K.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2397

Передозировка ингибиторами ангиотензинпревращающего фермента (иАПФ), особенно в сочетании с другими сердечнососудистыми препаратами, ограничена малым количеством публикаций. Серьезной проблемой являются передозировка комбинированными препаратами с фиксированной дозой и отравление несколькими препаратами одновременно. Отравление иАПФ имеет серьезные осложнения и способно привести к летальному исходу. Острые отравления иАПФ проявляются нарушениями гемоциркуляции, где одним из предрасполагающих механизмов декомпенсации кровообращения является несостоятельность кардиомиоцитов, патогенез которого до конца не изучен. Поэтому применяющиеся в настоящее время методы коррекции кардио- и гемодинамических нарушений не всегда дают положительный эффект. В статье подчеркиваются трудности клинической и функциональной диагностики и лечения передозировки иАПФ, комбинированными препаратами с фиксированной дозой, а также отравления несколькими препаратами

Overdose with angiotensin converting enzyme (ACE) inhibitors, especially in combination with other cardiovascular drugs, is limited by a small number of publications. A serious problem is an overdose with combined drugs with a fixed dose and poisoning with several drugs at the same time. ACE inhibitors poisoning has serious complications and can lead to a fatal outcome. Acute ACE inhibitors poisoning comes out in disorders of hemocirculation, where one of the predisposing mechanisms of decompensation of blood circulation is the failure of cardiomyocytes, the pathogenesis of which is not fully studied. Therefore, the currently used the methods of cardio- and hemodynamic disorders correction which are currently used do not always give a positive effect. The review highlights the difficulties of clinical and functional diagnosis and treatment of overdose with ACE inhibitors, combined drugs with a fixed dose, as well as poisoning with several drugs.

ингибиторы ангиотензинпревращающего ферментапередозировкакардиотоксичностькомбинированный препарат с фиксированной дозойотравление несколькими препаратамилечениеangiotensin converting enzyme inhibitorsoverdosecardiotoxicityfixed-dose combinationsmulti-drug intoxicationtreatmentReferencesBennett K, Johnson H, Dack P, Shelley E, Feely J. Changes in prevalence of and prescribing for ischaemic heart disease in Ireland 1990–2002. Ir J Med Sci. 2005 Jul-Sep; 174 (3): 4–8. DOI: 10.1007/BF03169139.Bennett K, Johnson H, Dack P, Shelley E, Feely J. Changes in prevalence of and prescribing for ischaemic heart disease in Ireland 1990–2002. Ir J Med Sci. 2005 Jul-Sep; 174 (3): 4–8. DOI: 10.1007/BF03169139.Gnani S, Gray J, Khunti K, Majeed A. Managing heart failure in primary care: first steps in implementing the National Service Framework. J Public Health (Oxf). 2004 Mar; 26 (1): 42–7. DOI: 10.1093/pubmed/fdh102.Gnani S, Gray J, Khunti K, Majeed A. Managing heart failure in primary care: first steps in implementing the National Service Framework. J Public Health (Oxf). 2004 Mar; 26 (1): 42–7. DOI: 10.1093/pubmed/fdh102.Gavras H, Gavras I. Angiotensin converting enzyme inhibitors. Properties and side effects. Hypertension. 1988 Mar; 11 (3 Pt 2): II 37–41. DOI: 10.1161/01.hyp.11.3_pt_2.ii37.Gavras H, Gavras I. Angiotensin converting enzyme inhibitors. Properties and side effects. Hypertension. 1988 Mar; 11 (3 Pt 2): II 37–41. DOI: 10.1161/01.hyp.11.3_pt_2.ii37.Christie GA, Lucas C, Bateman DN, Waring WS. Redefining the ACE-inhibitor dose-response relationship: substantial blood pressure lowering after massive doses. Eur J Clin Pharmacol. 2006 Dec; 62 (12): 989–93. DOI: 10.1007/s00228–006–0218–8.Christie GA, Lucas C, Bateman DN, Waring WS. Redefining the ACE-inhibitor dose-response relationship: substantial blood pressure lowering after massive doses. Eur J Clin Pharmacol. 2006 Dec; 62 (12): 989–93. DOI: 10.1007/s00228–006–0218–8.van Thiel BS, van der Pluijm I, te Riet L, Essers J, Danser AH. The renin-angiotensin system and its involvement in vascular disease. Eur J Pharmacol. 2015 Sep 15; 763 (Pt A): 3–14. DOI: 10.1016/j.ejphar.2015.03.090.van Thiel BS, van der Pluijm I, te Riet L, Essers J, Danser AH. The renin-angiotensin system and its involvement in vascular disease. Eur J Pharmacol. 2015 Sep 15; 763 (Pt A): 3–14. DOI: 10.1016/j.ejphar.2015.03.090.Del Fiorentino A, Cianchetti S, Celi A, Dell’Omo G, Pedrinelli R. The effect of angiotensin receptor blockers on C-reactive protein and other circulating inflammatory indices in man. Vasc Health Risk Manag. 2009; 5 (1): 233–42. DOI: 10.2147/vhrm.s4800.Del Fiorentino A, Cianchetti S, Celi A, Dell’Omo G, Pedrinelli R. The effect of angiotensin receptor blockers on C-reactive protein and other circulating inflammatory indices in man. Vasc Health Risk Manag. 2009; 5 (1): 233–42. DOI: 10.2147/vhrm.s4800.Sanjuliani A, Torres M, de Paula L, Bassan F. Eixo Renina-Angiotensina-Aldosterona: bases fisiológicas e fisiopatológicas. Revista Hospital Universitário Pedro Ernesto. 2011; 10 (3).Sanjuliani A, Torres M, de Paula L, Bassan F. Eixo Renina-Angiotensina-Aldosterona: bases fisiológicas e fisiopatológicas. Revista Hospital Universitário Pedro Ernesto. 2011; 10 (3).Kalkan S, Hocaoglu N, Oransay K, Unverir P, Tuncok Y. Cardiovascular medication exposures and poisonings in Izmir, Turkey: a 14-year experience. Hum Exp Toxicol. 2011 May; 30 (5): 347–53. DOI: 10.1177/0960327110371256.Kalkan S, Hocaoglu N, Oransay K, Unverir P, Tuncok Y. Cardiovascular medication exposures and poisonings in Izmir, Turkey: a 14-year experience. Hum Exp Toxicol. 2011 May; 30 (5): 347–53. DOI: 10.1177/0960327110371256.Lucas C, Christie GA, Waring WS. Rapid onset of haemodynamic effects after angiotensin converting enzyme-inhibitor overdose: implications for initial patient triage. Emerg Med J. 2006 Nov; 23 (11): 854–7. DOI: 10.1136/emj.2006.038836.Lucas C, Christie GA, Waring WS. Rapid onset of haemodynamic effects after angiotensin converting enzyme-inhibitor overdose: implications for initial patient triage. Emerg Med J. 2006 Nov; 23 (11): 854–7. DOI: 10.1136/emj.2006.038836.Watson WA, Litovitz TL, Rodgers GC Jr, Klein-Schwartz W, Reid N, Youniss J, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2005 Sep; 23 (5): 589–666. DOI: 10.1016/j.ajem.2005.05.001.Watson WA, Litovitz TL, Rodgers GC Jr, Klein-Schwartz W, Reid N, Youniss J, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2005 Sep; 23 (5): 589–666. DOI: 10.1016/j.ajem.2005.05.001.Park H, Purnell GV, Mirchandani HG. Suicide by captopril overdose. J Toxicol Clin Toxicol. 1990; 28 (3): 379–82. DOI: 10.3109/15563659008994439.Park H, Purnell GV, Mirchandani HG. Suicide by captopril overdose. J Toxicol Clin Toxicol. 1990; 28 (3): 379–82. DOI: 10.3109/15563659008994439.Barr CS, Payne R, Newton RW. Profound prolonged hypotension following captopril overdose. Postgrad Med J. 1991 Oct; 67 (792): 953–4. DOI: 10.1136/pgmj.67.792.953-a.Barr CS, Payne R, Newton RW. Profound prolonged hypotension following captopril overdose. Postgrad Med J. 1991 Oct; 67 (792): 953–4. DOI: 10.1136/pgmj.67.792.953-a.Долгих В.Т. Повреждение и защита сердца при острой смертельной кровопотере. Омск. 2002. 203 с.Dolgikh V.T. Heart damage and protection in acute fatal blood loss. Omsk. 2002.203 p.Ласукова Т. В., Арбузов А. Г., Маслов Л. Н. Экстракт Ganoderma lucidum при диастолической дисфункции сердца и возникновение необратимых повреждений кардиомиоцитов в условиях ишемии и реперфузии изолированного сердца. Патологическая физиология и экспериментальная терапия. 2008. № 1. С. 22–25.Lasukova T.V., Arbuzov A.G., Maslov L.N. Ganoderma lucidum extract in case of diastolic dysfunction of the heart and the occurrence of irreversible damage to cardiomyocytes in conditions of ischemia and reperfusion of an isolated heart. Pathological Physiology and Experimental Therapy. 2008. No. 1. P. 22–25.Goldfrank Ed. By L.R. Goldfrank’s tixicologic emergencies 5th. Ed. NY. 1994. 1589 p.Goldfrank Ed. By L.R. Goldfrank’s tixicologic emergencies 5th. Ed. NY. 1994. 1589 p.Keumerer D. Non-anion dap metabolic acidosis associatiated with acute on chronic topiramate ov erdose. J. Toxicol. Clin Toxicol. 2002; 40 (5): 691.Keumerer D. Non-anion dap metabolic acidosis associatiated with acute on chronic topiramate ov erdose. J. Toxicol. Clin Toxicol. 2002; 40 (5): 691.Элленхорн М. Дж. Медицинская токсикология. Диагностика и лечение отравлений у человека (в 2 т.). Пер. с англ. М.: Медицина. 2003. Т. 1. 1048 с.Ellenhorn M.J. Medical toxicology. Diagnostics and treatment of human poisoning (in 2 volumes). Transl. from English M.: Medicine. 2003. T. 1. 1048 p.Меерсон Ф.З. Адаптация, стресс и профилактика. М.: Наука. 1981. 278 с.Meerson F.Z. Adaptation, stress and prevention. M.: Science. 1981. 278 p.Афанасьев С. А., Роговская Ю. В., Фалалеева Л. П., Свиридов И. Н., Шахов В. П., Попов С.В. Сравнительная оценка ремоделирования сердца крысы после экспериментального стеноза коронарной артерии и криодеструкции. Бюллетень экспериментальной биологии и медицины. 2009; 147 (6): 631–4.Afanasyev S.A., Rogovskaya Yu.V., Falaleeva L.P., Sviridov I.N., Shakhov V.P., Popov S.V. Comparative evaluation of rat heart remodeling after experimental coronary artery stenosis and cryodestruction. Bulletin of Experimental Biology and Medicine. 2009; 147 (6): 631–4.Проскуряков С.Я., Филимонова М.В., Боровая О.Н., Кучеренко Н.Г., Тришкина А.И., Штейн Л.В. и др. Влияние NO-ингибиторов на гипотензию, вызванную гиповолемическим шоком. Бюллетень экспериментальной биологии и медицины. 2010; 150 (7): 23–7.Proskuryakov S. Ya., Filimonova M.V., Borovaya O.N., Kucherenko N.G., Trishkina A.I., Shtein L.V. et al. Effect of NO-inhibitors on hypotension induced by hypovolemic shock. Bulletin of Experimental Biology and Medicine. 2010; 150 (7): 23–7.Яцинюк Б.Б., Сенцов В.Г., Долгих В.Т., Брусин К.М. Сократимость и метаболизм изолированных сердец при токсических дозах ингибиторов АПФ. Вестник Уральской медицинской академической науки. 2010 (1): 71–5.Yatsinyuk B.B., Sentsov V.G., Dolgikh V.T., Brusin K.M. Contractility and metabolism of isolated hearts at toxic doses of ACE inhibitors. Bulletin of the Ural Medical Academic Science. 2010 (1): 71–5.Яцинюк Б. Б., Сенцов В. Г., Брусин К. М. Опыт терапии острых отравлений ингибиторами ангиотензинпревращающего фермента. Казанский медицинский журнал. 2011; 92 (3).Yatsinyuk B.B., Sentsov V.G., Brusin K.M. Experience in the treatment of acute poisoning with angiotensin-converting enzyme inhibitors. Kazan Medical Journal. 2011; 92 (3).Varughese A, Taylor AA, Nelson EB. Consequences of angiotensin-converting enzyme inhibitor overdose. Am J Hypertens. 1989 May; 2 (5 Pt 1): 355–7. DOI: 10.1093/ajh/2.5.355.Varughese A, Taylor AA, Nelson EB. Consequences of angiotensin-converting enzyme inhibitor overdose. Am J Hypertens. 1989 May; 2 (5 Pt 1): 355–7. DOI: 10.1093/ajh/2.5.355.Johnston GD, Smith AM. Management of overdose due to antihypertensive agents. Adverse Drug React Acute Poisoning Rev. 1990 Summer; 9 (2): 75–89. PMID: 1977294.Johnston GD, Smith AM. Management of overdose due to antihypertensive agents. Adverse Drug React Acute Poisoning Rev. 1990 Summer; 9 (2): 75–89. PMID: 1977294.Lip GY, Ferner RE. Poisoning with anti-hypertensive drugs: angiotensin converting enzyme inhibitors. J Hum Hypertens. 1995 Sep; 9 (9): 711–5. PMID: 8551483.Lip GY, Ferner RE. Poisoning with anti-hypertensive drugs: angiotensin converting enzyme inhibitors. J Hum Hypertens. 1995 Sep; 9 (9): 711–5. PMID: 8551483.Shrank WH, Ettner SL, Glassman P, Asch SM. A bitter pill: formulary variability and the challenge to prescribing physicians. J Am Board Fam Pract. 2004 Nov-Dec; 17 (6): 401–7. DOI: 10.3122/jabfm.17.6.401.Shrank WH, Ettner SL, Glassman P, Asch SM. A bitter pill: formulary variability and the challenge to prescribing physicians. J Am Board Fam Pract. 2004 Nov-Dec; 17 (6): 401–7. DOI: 10.3122/jabfm.17.6.401.Newby DE, Lee MR, Gray AJ, Boon NA. Enalapril overdose and the corrective effect of intravenous angiotensin II. Br J Clin Pharmacol. 1995 Jul; 40 (1): 103–4. DOI: 10.1111/j.1365–2125.1995.tb04546.x.Newby DE, Lee MR, Gray AJ, Boon NA. Enalapril overdose and the corrective effect of intravenous angiotensin II. Br J Clin Pharmacol. 1995 Jul; 40 (1): 103–4. DOI: 10.1111/j.1365–2125.1995.tb04546.x.Trilli LE, Johnson KA. Lisinopril overdose and management with intravenous angiotensin II. Ann Pharmacother. 1994 Oct; 28 (10): 1165–8. DOI: 10.1177/106002809402801006.Trilli LE, Johnson KA. Lisinopril overdose and management with intravenous angiotensin II. Ann Pharmacother. 1994 Oct; 28 (10): 1165–8. DOI: 10.1177/106002809402801006.Suchard JR, Bearie BJ. Quinapril overdose-induced renal failure. Cal J Emerg Med. 2002 Jan; 3 (1): 9–10. PMID: 20852701.Suchard JR, Bearie BJ. Quinapril overdose-induced renal failure. Cal J Emerg Med. 2002 Jan; 3 (1): 9–10. PMID: 20852701.Belay TW, Nusair AR. Apparent lisinopril overdose requiring hemodialysis. Am J Health Syst Pharm. 2013 Jul 15; 70 (14): 1226–9. DOI: 10.2146/ajhp120734.Belay TW, Nusair AR. Apparent lisinopril overdose requiring hemodialysis. Am J Health Syst Pharm. 2013 Jul 15; 70 (14): 1226–9. DOI: 10.2146/ajhp120734.Brown NJ, Vaughan DE. Angiotensin-converting enzyme inhibitors. Circulation. 1998 Apr 14; 97 (14): 1411–20. DOI: 10.1161/01.cir.97.14.1411.Brown NJ, Vaughan DE. Angiotensin-converting enzyme inhibitors. Circulation. 1998 Apr 14; 97 (14): 1411–20. DOI: 10.1161/01.cir.97.14.1411.Giannattasio C, Grassi G, Seravalle G, Morganti A, Zanchetti A, Mancia G. Investigation of reflexes from volume and baroreceptors during converting-enzyme inhibition in humans. Am Heart J. 1989 Mar; 117 (3): 740–5. DOI: 10.1016/0002–8703(89)90764–3.Giannattasio C, Grassi G, Seravalle G, Morganti A, Zanchetti A, Mancia G. Investigation of reflexes from volume and baroreceptors during converting-enzyme inhibition in humans. Am Heart J. 1989 Mar; 117 (3): 740–5. DOI: 10.1016/0002–8703(89)90764–3.Shruthi B, Bharath T, Muthuraju N. Attempted Suicide with Enalapril: A Rare Case of Poisoning. Sch J Med Case Rep. 2014; 2 (10): 700–701.Shruthi B, Bharath T, Muthuraju N. Attempted Suicide with Enalapril: A Rare Case of Poisoning. Sch J Med Case Rep. 2014; 2 (10): 700–701.Capes KF. Angiotensin converting enzyme inhibitors. In Viccellio P ed. Emergency toxicology, second edition. Lippincott-Raven, 1998: 681–5.Capes KF. Angiotensin converting enzyme inhibitors. In Viccellio P ed. Emergency toxicology, second edition. Lippincott-Raven, 1998: 681–5.Leiken JB, Paloucek FP. Poison and toxicology compendium with symptoms index. Lexi-Corp Inc., 1998, 356–7.Leiken JB, Paloucek FP. Poison and toxicology compendium with symptoms index. Lexi-Corp Inc., 1998, 356–7.Dawson AH, Harvey D, Smith AJ, Taylor M, Whyte IM, Johnson CI, Cubela RB, Roberts MJ. Lisinopril overdose. Lancet. 1990 Feb 24; 335 (8687): 487–8. DOI: 10.1016/0140–6736(90)90731-j.Dawson AH, Harvey D, Smith AJ, Taylor M, Whyte IM, Johnson CI, Cubela RB, Roberts MJ. Lisinopril overdose. Lancet. 1990 Feb 24; 335 (8687): 487–8. DOI: 10.1016/0140–6736(90)90731-j.Forrester MB. Adult lisinopril ingestions reported to Texas poison control centers, 19982005. Hum Exp Toxicol. 2007 Jun; 26 (6): 483–9. DOI: 10.1177/0960327107073416.Forrester MB. Adult lisinopril ingestions reported to Texas poison control centers, 19982005. Hum Exp Toxicol. 2007 Jun; 26 (6): 483–9. DOI: 10.1177/0960327107073416.Robert M, De Bels D, Chaumont M, Honoré PM, Gottignies P. Angiotensin converting enzyme inhibitor intoxication: Naloxone to the rescue? Naloxone for ACE inhibitor intoxication. Am J Emerg Med. 2019 Jun; 37 (6): 1217.e1–1217.e2. DOI: 10.1016/j.ajem.2019.03.046.Robert M, De Bels D, Chaumont M, Honoré PM, Gottignies P. Angiotensin converting enzyme inhibitor intoxication: Naloxone to the rescue? Naloxone for ACE inhibitor intoxication. Am J Emerg Med. 2019 Jun; 37 (6): 1217.e1–1217.e2. DOI: 10.1016/j.ajem.2019.03.046.Khalaf MA, Mohamed ZT. New strategy for treating acute captopril overdose-induced hypotension: Naloxone as an antidote in refractory cases: Clinical study. Ain Shams J. Foren. Med. Clin. Toxicol. 2005; 64: 73.Khalaf MA, Mohamed ZT. New strategy for treating acute captopril overdose-induced hypotension: Naloxone as an antidote in refractory cases: Clinical study. Ain Shams J. Foren. Med. Clin. Toxicol. 2005; 64: 73.Avci A, Yilmaz A, Celik M, Demir K, Keles F. Successful treatment of suicide attempt by megadose of propafenone and captopril. Cardiovasc Toxicol. 2013 Sep; 13 (3): 230–3. DOI: 10.1007/s12012–013–9201–7.Avci A, Yilmaz A, Celik M, Demir K, Keles F. Successful treatment of suicide attempt by megadose of propafenone and captopril. Cardiovasc Toxicol. 2013 Sep; 13 (3): 230–3. DOI: 10.1007/s12012–013–9201–7.Varon J, Duncan SR. Naloxone reversal of hypotension due to captopril overdose. Ann Emerg Med. 1991 Oct; 20 (10): 1125–7. DOI: 10.1016/s0196–0644(05)81389–7.Varon J, Duncan SR. Naloxone reversal of hypotension due to captopril overdose. Ann Emerg Med. 1991 Oct; 20 (10): 1125–7. DOI: 10.1016/s0196–0644(05)81389–7.Roberge RJ, Rossetti ML, Rosetti JM. Aminophylline reversal of antihypertensive agent toxicity. Vet Hum Toxicol. 2001 Oct; 43 (5): 285–7. PMID: 11577934.Roberge RJ, Rossetti ML, Rosetti JM. Aminophylline reversal of antihypertensive agent toxicity. Vet Hum Toxicol. 2001 Oct; 43 (5): 285–7. PMID: 11577934.Brunton LL, Chabner BA, Knollmann BC. Goodman and Gilman’s the pharmacologic basis of therapeutics. 12th ed. New York: McGraw-Hill; 2011: 789–814.Brunton LL, Chabner BA, Knollmann BC. Goodman and Gilman’s the pharmacologic basis of therapeutics. 12th ed. New York: McGraw-Hill; 2011: 789–814.Stycuła W, Borówka M, Jarosz J, Kołcz J, Skalski J. Zastosowanie pozaustrojowego utlenowania krwi i wspomagania krazenia oraz ciagłej zylno-zylnej hemodiafiltracji w ciezkim zatruciu inhibitorem konwertazy, blokerem kanalu Ca++ i beta-blokerem [The use of extracorporeal life support and continuous venovenous haemodiafiltration in severe angiotensin converting enzyme inhibitor, calcium channel bloker and beta-blocker multidrug intoxication]. Przegl Lek. 2013; 70 (11): 993–6. Polish. PMID: 24697046.Stycuła W, Borówka M, Jarosz J, Kołcz J, Skalski J. Zastosowanie pozaustrojowego utlenowania krwi i wspomagania krazenia oraz ciagłej zylno-zylnej hemodiafiltracji w ciezkim zatruciu inhibitorem konwertazy, blokerem kanalu Ca++ i beta-blokerem [The use of extracorporeal life support and continuous venovenous haemodiafiltration in severe angiotensin converting enzyme inhibitor, calcium channel bloker and beta-blocker multidrug intoxication]. Przegl Lek. 2013; 70 (11): 993–6. Polish. PMID: 24697046.Bilir B, Şakacı M, Bilir BE, Altındal M, Oran M, Eroğlu O, Kara SP, Sedef S. Perindopril/ Amlodipin Aşırı Doz Kullanımına Bağlı Akut Böbrek Yetmezliği Vakası. International Journal of Basic and Clinical Medicine; 4 (2).Bilir B, Şakacı M, Bilir BE, Altındal M, Oran M, Eroğlu O, Kara SP, Sedef S. Perindopril/ Amlodipin Aşırı Doz Kullanımına Bağlı Akut Böbrek Yetmezliği Vakası. International Journal of Basic and Clinical Medicine; 4 (2).Sandeep P, Ram R, Sowgandhi N, Reddy SA, Katyarmal DT, Kumar BS, Kumar VS. Atenolol and amlodipine combination overdose managed with continuous venovenous hemodiafiltration: A case report. Indian J Nephrol. 2014 Sep; 24 (5):327–9. DOI: 10.4103/0971–4065.133033.Sandeep P, Ram R, Sowgandhi N, Reddy SA, Katyarmal DT, Kumar BS, Kumar VS. Atenolol and amlodipine combination overdose managed with continuous venovenous hemodiafiltration: A case report. Indian J Nephrol. 2014 Sep; 24 (5):327–9. DOI: 10.4103/0971–4065.133033.Shoaib MI, Alrais ZF, Elkhouly A. High Dosage Insulin Therapy in Calcium Channel Blocker and Beta Blocker Overdosage. Journal of Case Reports. 2016 Apr 7; 6 (1): 135–8.Shoaib MI, Alrais ZF, Elkhouly A. High Dosage Insulin Therapy in Calcium Channel Blocker and Beta Blocker Overdosage. Journal of Case Reports. 2016 Apr 7; 6 (1): 135–8.Jović-Stosić J, Putić V, Zivanović D, Mladenov M, Brajković G, Djordjević S. Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers. Vojnosanit Pregl. 2016 Jan; 73 (1): 88–91. DOI: 10.2298/vsp141216018j.Jović-Stosić J, Putić V, Zivanović D, Mladenov M, Brajković G, Djordjević S. Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers. Vojnosanit Pregl. 2016 Jan; 73 (1): 88–91. DOI: 10.2298/vsp141216018j.Cohen V, Jellinek SP, Fancher L, Sangwan G, Wakslak M, Marquart E, et al. Tarka® (trandolapril/verapamil hydrochloride extended-release) overdose. J Emerg Med. 2011 Mar; 40 (3): 291–5. DOI: 10.1016/j.jemermed.2008.10.015.Cohen V, Jellinek SP, Fancher L, Sangwan G, Wakslak M, Marquart E, et al. Tarka® (trandolapril/verapamil hydrochloride extended-release) overdose. J Emerg Med. 2011 Mar; 40 (3): 291–5. DOI: 10.1016/j.jemermed.2008.10.015.Delk C, Holstege CP, Brady WJ. Electrocardiographic abnormalities associated with poisoning. Am J Emerg Med. 2007 Jul; 25 (6): 672–87. DOI: 10.1016/j.ajem.2006.11.038.Delk C, Holstege CP, Brady WJ. Electrocardiographic abnormalities associated with poisoning. Am J Emerg Med. 2007 Jul; 25 (6): 672–87. DOI: 10.1016/j.ajem.2006.11.038.Tale S, Kumar M, Ghosh S, Bhalla A. A Case of Life-threatening Amlodipine and Atenolol Overdose. Indian J Crit Care Med. 2019 Jun; 23 (6): 281–283. DOI: 10.5005/jp-journals-10071–23181.Tale S, Kumar M, Ghosh S, Bhalla A. A Case of Life-threatening Amlodipine and Atenolol Overdose. Indian J Crit Care Med. 2019 Jun; 23 (6): 281–283. DOI: 10.5005/jp-journals-10071–23181.Huang J, Buckley NA, Isoardi KZ, Chiew AL, Isbister GK, Cairns R, Brown JA, Chan BS. Angiotensin axis antagonists increase the incidence of haemodynamic instability in dihydropyridine calcium channel blocker poisoning. Clin Toxicol (Phila). 2021 Jun; 59 (6): 464–471. DOI: 10.1080/15563650.2020.1826504.Huang J, Buckley NA, Isoardi KZ, Chiew AL, Isbister GK, Cairns R, Brown JA, Chan BS. Angiotensin axis antagonists increase the incidence of haemodynamic instability in dihydropyridine calcium channel blocker poisoning. Clin Toxicol (Phila). 2021 Jun; 59 (6): 464–471. DOI: 10.1080/15563650.2020.1826504.Newton CR, Delgado JH, Gomez HF. Calcium and beta receptor antagonist overdose: a review and update of pharmacological principles and management. Semin Respir Crit Care Med. 2002 Feb; 23 (1): 19–25. DOI: 10.1055/s-2002–20585.Newton CR, Delgado JH, Gomez HF. Calcium and beta receptor antagonist overdose: a review and update of pharmacological principles and management. Semin Respir Crit Care Med. 2002 Feb; 23 (1): 19–25. DOI: 10.1055/s-2002–20585.

The authors declare that there are no conflicts of interest present.