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In connection with Amlodipine: In humans experience with intentional overdose is limited.
Symptoms: Available data suggest that gross overdosage could result in excessive peripheral vasodilatation and possibly reflex tachycardia. Marked and probably prolonged systemic hypotension up to and including shock with fatal outcome have been reported.
Treatment: Clinically significant hypotension due to Amlodipine overdosage calls for active cardiovascular support including frequent monitoring of cardiac and respiratory function, elevation of extremities and attention to circulating fluid volume and urine output.
A vasoconstrictor may be helpful in restoring vascular tone and blood pressure, provided that there is no contraindication to its use. Intravenous calcium gluconate may be beneficial in reversing the effects of calcium channel blockade.
Gastric lavage may be worthwhile in some cases. In healthy volunteers the use of charcoal up to 2 hours after administration of Amlodipine 10 mg has been shown to reduce the absorption rate of Amlodipine.
Since Amlodipine is highly protein-bound, dialysis is not likely to be of benefit.
In connection with Bisoprolol: Symptoms: The most common signs expected with overdosage of a beta-blocker are bradycardia, hypotension, bronchospasm, acute cardiac insufficiency and hypoglycaemia. To date a few cases of overdose with Bisoprolol in hypertensive and/or ischemic heart disease patients have been reported: Bradycardia and/or hypotension were noted. All patients recovered. There is a wide interindividual variation in sensitivity and in reactions to one single high dose of Bisoprolol, patients with heart disease are obviously more sensitive to the effects of Bisoprolol.
Treatment: In general, if overdose occurs, Bisoprolol treatment should be stopped and supportive and symptomatic treatment should be provided. Limited data suggest that bisorolol is hardly dialysable.
Based on the expected pharmacological actions and recommendations for other beta-blockers, the following general measures should be considered when clinically warranted.
Bradycardia: Administer intravenous atropine. If the response is inadequate, lsoprenaline or another agent with positive chronotropic properties may be given cautiously. Under some circumstances, transvenous pacemaker insertion may be necessary.
Hypotension: Intravenous fluids and vasopressors should be administered. Intravenous glucagon may be useful.
AV block (second or third degree): Patients should be carefully monitored and treated with lsoprenaline infusion or cardiac pacemaker insertion.
Acute worsening of heart failure: i v. diuretics, positive inotropic agents, vasodilating agents should be administered.
Bronchospasm: Bronchodilator therapy such as lsoprenaline, beta2-sympathomimetic drugs and/or Aminophylline should be administered.
Hypoglycaemia: iv. glucose should be administered.
