Кардиотоксичность гипотензивных препаратов (обзор литературы) Часть I. Блокаторы кальциевых каналов и β-блокаторы
https://doi.org/10.33667/2078-5631-2021-25-12-19
Аннотация
Токсическое воздействие при передозировке гипотензивными препаратами на сердечно-сосудистую систему является малоизученной темой, объединяющей клиническую, экспериментальную фармакологию и токсикологию с проекцией на кардиологию. Имеющиеся в научной литературе описания кардиотоксичности бета-блокаторов (βБ) и блокаторов кальциевых каналов (БКК) ограничены малым количеством публикаций. Отравления этими группами препаратов проявляются схожими серьезными гемодинамическими нарушениями и миокардиальной недостаточностью, однако патофизиологические механизмы этих изменений до конца не изучены. В статье подчеркиваются трудности определения токсической концентрации и особенности клинической картины отравлений. Обсуждаются подходы к диагностике и лечению передозировки БКК и βБ.
Об авторах
А. Н. ЭсауленкоРоссия
Эсауленко Анна Николаевна, клинический ординатор по специальности «кардиология»
А. Ю. Моисеева
Россия
Моисеева Александра Юрьевна, клинический ординатор по специальности «кардиология»
А. А. Иванников
Россия
Иванников Александр Александрович, клинический ординатор по специальности «кардиология»
И. В. Братищев
Россия
Братищев Игорь Викторович. врач – анестезиолог-реаниматолог, преподаватель учебного центра
Х. Г. Алиджанова
Россия
Алиджанова Хафиза Гафуровна, д. м. н., ст. преподаватель учебного центра
Список литературы
1. Mokhlesi B, Leikin JB, Murray P, Corbridge TC. Adult Toxicology in Critical Carea: Part II: Specific Poisonings. Chest. 2003; 123 (3): 897–922. https://doi.org/10.1378/chest.123.3.897
2. Wax PM, Erdman AR, Chyka PA, Keyes DC, Caravati EM, Booze L, et al. βetablocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005; 43 (3): 131–146.
3. Лужников Е. А. (ред.) Медицинская токсикология: национальное руководство. Москва: ГЭОТАР-Медиа, 2012. 928 с.
4. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila). 2014; 52 (10): 1032–1283. https://doi.org/10.3109/15563650.2014.987397
5. Лагуткина Т. П., Аксенова П. Н., Саломатин Е. М. Отравления лекарственными средствами как индикатор социальной напряженности и социального неблагополучия. Судебно-медицинская экспертиза. 2011; 54 (4): 23–26.
6. Белова М. В., Ильяшенко К. К. Острые отравления кардиотоксическими препаратами по данным Московского городского токсикологического центра за период 2010–2014 гг. В кн.: Здоровье столицы‑2015: тез. докл. ХIV Моск. ассамблеи, (19–20 ноября 2015 г.). Москва, 2015. с. 209–210.
7. Мельников Е. С. Химико-токсикологический анализ гипотензивных лекарственных средств при острых отравлениях: дис. … канд. фарм. наук. Москва, 2016. 112 с.
8. Balit CR, Isbister GK, Hackett LP, Whyte IM. Quetiapine poisoning: a case series. Ann Emerg Med. 2003; 42 (6): 751–758. https://doi.org/10.1016/s0196–0644(03)00600–0
9. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017; 55 (10): 1072–1252. https://doi.org/10.1080/15563650.2017.1388087
10. Menke NB, Walsh SJ, King AM. Cardiotoxicodynamics: Toxicity of Cardiovascular Xenobiotics. Emerg Med Clin North Am. 2015; 33 (3): 563–595. https://doi.org/10.1016/j.emc.2015.04.007
11. Chodorowski Z, Anand JS, Waldman W. Suicidal poisoning with antihypertensive drugs. Przegl Lek. 2003; 60 (4): 233–235.
12. Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. 2020 Nov 21. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020 Jan. PMID: 28846217.
13. Spedding M, Paoletti R. Classification of calcium channels and the sites of action of drugs modifying channel function. Pharmacol Rev. 1992; 44 (3): 363–376.
14. Gupta B, Kerai S. Amlodipine toxicity complicated by concurrent medications. Korean J Anesthesiol. 2018; 71 (6): 489–490. https://doi.org/10.4097/kja.d.17.00071
15. Shenoy S, Lankala S, Adigopula S. Management of calcium channel blocker overdoses. J Hosp Med. 2014; 9 (10): 663–668. https://doi.org/10.1002/jhm.2241
16. St-Onge M, Dubé PA, Gosselin S, Guimont C, Godwin J, Archambault PM, et al. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol (Phila). 2014; 52 (9): 926–944. https://doi.org/10.3109/155636502014.965827
17. Kerns W 2nd. Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am. 2007; 25 (2): 309–331; abstract VIII. https://doi.org/10.1016/j.emc.2007.02.001
18. Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol. 2016; 81 (3): 453–461. https://doi.org/10.1111/bcp.12763
19. Engebretsen KM, Kaczmarek KM, Morgan J, Holger JS. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol (Phila). 2011; 49 (4): 277–283. https://doi.org/10.3109/15563650.2011.582471
20. Pearigen PD, Benowitz NL. Poisoning due to calcium antagonists. Experience with verapamil, diltiazem and nifedipine. Drug Saf. 1991; 6 (6): 408–430. https://doi.org/10.2165/00002018–199106060–00003
21. Lupi GA, Urthaler F, James TN. Effects of verapamil on automaticity and conduction with particular reference to tachyphylaxis. Eur J Cardiol. 1979; 9 (5): 345–368.
22. Brunton L, Chabner B, Knollman B. Goodman & Gilman’s the Pharmacological Basis of Therapeutics. 12th ed. New York: Mc Graw-Hill; 2011.
23. Henrikson CA, Chandra-Strobos N. Calcium channel blocker overdose mimicking an acute myocardial infarction. Resuscitation. 2003; 59 (3): 361–364. https://doi.org/10.1016/s0300–9572(03)00242–9
24. Chimienti M, Previtali M, Medici A, Piccinini M. Acute verapamil poisoning: successful treatment with epinephrine. Clin Сardiol. 1982; 5 (3): 219–222. https://doi.org/10.1002/clc.4960050304
25. Miranda CH, Xavier L, Fiorante F, Misiara GP, Guimarães EG, Galli AM, et al. Cardiac rhythm disturbances associated with amlodipine acute intoxication. Cardiovasc Toxicol. 2012; 12 (4): 359–362. https://doi.org/10.1007/s12012–012–9176–9
26. Rathore A, Ranjan NK, Sadananda KS, Basappa H, Manjunath CN. A survival case of amlodipine poisoning. Indian J Case Rep. 2017; 3 (4): 242–243. https://doi.org/10.32677/IJCR.2017.v03.i04.025
27. Lionte C, Bologa C, Sorodoc L. Toxic and drug-induced changes of the electrocardiogram. In: Advances in Electrocardiograms: Clinical Applications. Rijeka, Croatia: InTech, 2012. p. 271–296. https://doi.org/10.5772/22891
28. Spiller HA, Milliner BA, Bosse GM. Amlodipine fatality in an infant with postmortem blood levels. J Med Toxicol. 2012; 8 (2): 179–182. https://doi.org/10.1007/s13181–011–0207-x
29. Kute VB, Shah PR, Goplani KR, Gumber MR, Vanikar AV, Trivedi HL. Successful treatment of refractory hypotension, noncardiogenic pulmonary edema and acute kidney injury after an overdose of amlodipine. Indian J Crit Care Med. 2011; 15 (3): 182–184. https://doi.org/10.4103/0972–5229.84901
30. Proano L, Chiang WK, Wang RY. Calcium channel blocker overdose. Am J Emerg Med. 1995; 13 (4): 444–450. https://doi.org/10.1016/0735–6757(95)90137-X
31. Samniah N, Schlaeffer F. Cerebral infarction associated with oral verapamil overdose. J Toxicol Clin Toxicol. 1988; 26 (5–6): 365–369. https://doi.org/10.1080/15563658809167100
32. Anderson AC. Management of beta-adrenergic blocker poisoning. Clin Pediatr Emerg Med. 2008; 9 (1): 4–16. https://doi.org/10.1016/j.cpem.2007.12.001
33. DeWitt CR, Waksman JC. Pharmacology, pathophysiology and management of calcium channel blocker and β-blocker toxicity. Toxicol Rev. 2004; 23 (4): 223–238. https://doi.org/10.2165/00139709–200423040–00003
34. Shepherd G. Treatment of poisoning caused by β-adrenergic and calcium-channel blockers. Am J Health Syst Pharm. 2006; 63 (19): 1828–1835. https://doi.org/10.2146/ajhp060041
35. Carlin TM. Beta-blocker toxicity. In: Tintinalli JE, Kelen GD, Stapczynski JS. (eds). Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw-Hill; 2004. p. 1105–1108.
36. Darmansjah I, Wong E, Setiawati A, Moeloek D, Irawati D, Siagian M, et al. Pharmacokinetic and pharmacodynamic properties of controlled release (CR/ ZOK) metoprolol in healthy Oriental subjects: a comparison with conventional formulations of metoprolol and atenolol. J Clin Pharmacol. 1990; 30 (S 2): S 39–S 45. https://doi.org/10.1002/j.1552–4604.1990.tb03494.x
37. Chen TW, Huang TP, Yang WC, Hong CY. Propranolol intoxication: three cases’ experiences. Vet Hum Toxicol. 1985; 27 (6): 528–530.
38. Love JN, Howell JM, Litovitz TL, Klein-Schwartz W. Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity. J Toxicol Clin Toxicol. 2000; 38 (3): 275–281. https://doi.org/10.1081/clt‑100100932
39. Reith DM, Dawson AH, Epid D, Whyte IM, Buckley NA, Sayer GP. Relative toxicity of beta blockers in overdose. J Toxicol Clin Toxicol. 1996; 34 (3): 273–278. https://doi.org/10.3109/15563659609013789
40. Love JN, Litovitz TL, Howell JM, Clancy C. Characterization of fatal beta blocker ingestion: a review of the American Association of Poison Control Centers data from 1985 to 1995. J Toxicol Clin Toxicol. 1997; 35 (4): 353–359. https://doi.org/10.3109/15563659709043366
41. Shore ET, Cepin D, Davidson MJ. Metoprolol overdose. Ann Emerg Med. 1981; 10 (10): 524–527. https://doi.org/10.1016/s0196–0644(81)80008-x
42. Kollef MH. Labetalol overdose successfully treated with amrinone and alpha-adrenergic receptor agonists. Chest. 1994; 105 (2): 626–627. https://doi.org/10.1378/chest.105.2.626
43. Batul SA, Gopinathannair R. Intravenous Sotalol – Reintroducing a Forgotten Agent to the Electrophysiology Therapeutic Arsenal. J Atr Fibrillation. 2017; 9 (5): 1499. https://doi.org/10.4022/jafib.1499eCollectionFeb-Mar2017.
44. Neuvonen PJ, Elonen E, Vuorenmaa T, Laakso M. Prolonged Q-T interval and severe tachyarrhythmias, common features of sotalol intoxication. Eur J Clin Pharmacol. 1981; 20 (2): 85–89. https://doi.org/10.1007/BF00607142
45. Satar S, Acikalin A, Akpinar O. Unusual electrocardiographic changes with propranolol and diltiazem overdosage: a case report. Am J Ther. 2003; 10 (4): 299–302. https://doi.org/10.1097/00045391–200307000–00011
46. Delk C, Holstege CP, Brady WJ. Electrocardiographic abnormalities associated with poisoning. Am J Emerg Med. 2007; 25 (6): 672–687. https://doi.org/10.1016/j.ajem.2006.11.038
47. Love JN, Enlow B, Howell JM, Klein-Schwartz W, Litovitz TL. Electrocardiographic changes associated with beta-blocker toxicity. Ann Emerg Med. 2002; 40 (6): 603–610. https://doi.org/10.1067/mem.2002.129829
48. Ramos K, Melchert R, Chacon E, Acosta D. Toxic responses of the heart and vascular systems. In: Casarett LJ, Doull J, Klaassen CD, (eds). Casarett and Doull’s toxicology. The basic science of poisons. 6th ed. New York: McGraw-Hill Medical Pub. Division; 2001. p. 597–651.
49. Shanker UR, Webb J, Kotze A. Sodium bicarbonate to treat massive beta blocker overdose. Emerg Med J. 2003; 20 (4): 393. https://doi.org/10.1136/emj.20.4.393
50. Assimes TL, Malcolm I. Torsade de pointes with sotalol overdose treated successfully with lidocaine. Can J Cardiol. 1998; 14 (5): 753–756.
51. Elonen E, Neuvonen PJ, Tarssanen L, Kala R. Sotalol intoxication with prolonged Q-T interval and severe tachyarrhythmias. Br Med J. 1979; 1 (6172): 1184. https://doi.org/10.1136/bmj.1.6172.1184
52. Vale JA, Kulig K; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position paper: gastric lavage. J Toxicol Clin Toxicol. 2004; 42 (7): 933–943. https://doi.org/10.1081/clt‑200045006
53. Love JN, Hanfling D, Howell JM. Hemodynamic effects of calcium chloride in a canine model of acute propranolol intoxication. Ann Emerg Med. 1996; 28 (1): 1–6. https://doi.org/10.1016/s0196–0644(96)70129–4
54. Prichard BN, Battersby LA, Cruickshank JM. Overdosage with beta-adrenergic blocking agents. Adverse Drug React Acute Poisoning Rev. 1984; 3 (2): 91–111.
55. Kerns W, Schroeder D, Williams C, Tomaszewski C, Raymond R. Insulin improves survival in a canine model of acute beta-blocker toxicity. Ann Emerg Med. 1997; 29 (6): 748–757. https://doi.org/10.1016/s0196–0644(97)70196–3
56. Manchester JH, Parmley WW, Matloff JM, Leidtke AJ, LaRaia PJ, Herman MV, et al. Effects of glucagon on myocardial oxygen consumption and coronary blood flow in man and in dog. Circulation. 1970; 41 (4): 579–588. https://doi.org/10.1161/01.cir.41.4.579
57. Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? J Clin Invest. 2004; 114 (9): 1187–1195. https://doi.org/10.1172/JCI23506
58. Krenz JR, Kaakeh Y. An Overview of Hyperinsulinemic-Euglycemic Therapy in Calcium Channel Blocker and β-blocker Overdose. Pharmacotherapy. 2018; 38 (11): 1130–1142. https://doi.org/10.1002/phar.2177
59. Lewis M, Kallenbach J, Germond C, Zaltzman M, Muller F, Steyn J, et al. Survival following massive overdose of adrenergic blocking agents (acebutolol and labetalol). Eur Heart J. 1983; 4 (5): 328–332. https://doi.org/10.1093/oxfordjournals.eurheartj.a061469
60. Critchley JA, Ungar A. The management of acute poisoning due to beta-adrenoceptor antagonists. Med Toxicol Adverse Drug Exp. 1989; 4 (1): 32–45. https://doi.org/10.1007/BF03259901
61. Whitehurst VE, Vick JA, Alleva FR, Zhang J, Joseph X, Balazs T. Reversal of propranolol blockade of adrenergic receptors and related toxicity with drugs that increase cyclic AMP. Proc Soc Exp Biol Med. 1999; 221 (4): 382–385. https://doi.org/10.1046/j.1525–1373.1999.d01–96.x
62. Lane AS, Woodward AC, Goldman MR. Massive propranolol overdose poorly responsive to pharmacologic therapy: use of the intra-aortic balloon pump. Ann Emerg Med. 1987; 16 (12): 1381–1383. https://doi.org/10.1016/s0196–0644(87)80425–0
Рецензия
Для цитирования:
Эсауленко А.Н., Моисеева А.Ю., Иванников А.А., Братищев И.В., Алиджанова Х.Г. Кардиотоксичность гипотензивных препаратов (обзор литературы) Часть I. Блокаторы кальциевых каналов и β-блокаторы. Медицинский алфавит. 2021;(25):12-19. https://doi.org/10.33667/2078-5631-2021-25-12-19
For citation:
Esaulenko A.N., Moiseeva A.Yu., Ivannikov A.A., Bratischev I.V., Alidzhanova Kh.G. Cardiotoxicity with antihypertensive drugs (literature review) Part 1. Calcium channel blockers and beta-blockers. Medical alphabet. 2021;(25):12-19. (In Russ.) https://doi.org/10.33667/2078-5631-2021-25-12-19