Plendil Overdosage

Toxicity: 10 mg to a two-year-old child caused mild intoxication. 150-200 mg to a 17-year-old and 250 mg to an adult caused mild to moderate intoxication. Felodipine probably has a more pronounced effect on the peripheral circulation than on the heart, compared with other drugs in the same group.
Symptoms: The symptoms of intoxication with extended-release tablets may be delayed 12-16 hours and severe symptoms may set in after several days. Circulatory effects constitute the greatest risk: bradycardia (sometimes tachycardia), AV block I-III, AV dissociation, VES, ventricular fibrillation, asystole. Dizziness, headache, impaired consciousness, coma, spasms. Dyspnoea, lung oedema (non-cardiac) and apnoea. Possibly ARDS (Adult Respiratory Distress Syndrome). Acidosis, hypokalaemia, hyperglycaemia, potentially hypocalcaemia. Flush, hypothermia. Nausea and vomiting.
Management: Activated charcoal, gastric lavage if indicated, in certain cases also late after exposure (extended-release tablets can aggregrate).
Atropine (0.25-0.5 mg intravenously to adults, 10-20 mcg/kg to children) should be given before gastric lavage (due to the risk of vagal stimulation).
ECG monitoring. Respirator treatment on broad indication. Correction of acid-base and electrolyte status.
If severe hypotension occurs, symptomatic treatment should be initiated. The patient should be placed in a supine position with the legs elevated. In the event of accompanying bradycardia, 0.5-1.0 mg atropine should be administered intravenously. If this is not sufficient, plasma volume should be increased by infusion of e.g. glucose, saline or dextran. Sympathomimetics with predominant effect on the α1-adrenoceptor may be given if the aforementioned measures are not sufficient.
In circulatory arrest, resuscitation attempts may be required during several hours. In the case of spasms, diazepam should be given. Otherwise symptomatic therapy.