From the Guidelines
The treatment for beta blocker overdose should prioritize high-dose insulin and vasopressors for hypotension, as well as glucagon for bradycardia or hypotension, according to the most recent guidelines. The management of beta blocker overdose involves a combination of supportive care and specific antidotes. Initial steps include securing the airway, providing supplemental oxygen, establishing IV access, and cardiac monitoring. For symptomatic patients, the following treatments are recommended:
- High-dose insulin therapy, as recommended by the 2023 American Heart Association guidelines 1, which suggests its use for hypotension due to β-blocker poisoning refractory to or in conjunction with vasopressor therapy.
- Vasopressors, such as those recommended in the 2023 guidelines 1, for hypotension due to β-blocker poisoning.
- Glucagon, which can be used for bradycardia or hypotension, as suggested by the 2023 guidelines 1 and the 2020 American Heart Association guidelines 1. Additional treatments may include:
- Atropine for β-blocker–induced bradycardia, as suggested by the 2023 guidelines 1.
- Electrical pacing for β-blocker–induced bradycardia, as suggested by the 2023 guidelines 1.
- Extracorporeal life support techniques, such as VA-ECMO, for life-threatening β-blocker poisoning with cardiogenic shock refractory to pharmacological interventions, as recommended by the 2023 guidelines 1.
- Hemodialysis for life-threatening atenolol or sotalol poisoning, as suggested by the 2023 guidelines 1. It is essential to note that intravenous lipid emulsion therapy is not likely to be beneficial for life-threatening β-blocker poisoning, as stated in the 2023 guidelines 1.
From the FDA Drug Label
If overdosage occurs, the patient may experience nausea, vomiting, inhibition of GI tract motility, increase in blood pressure and pulse rate. The treatment for beta (beta blockers) antagonist overdose is not directly mentioned in the provided text.
- Glucagon (IV) is the drug mentioned in the label, but its use for beta blocker overdose is not explicitly stated.
- The label discusses treatment for overdosage of glucagon (IV) itself, not beta blockers.
- Phentolamine mesylate is mentioned as a treatment for a dramatic increase in blood pressure, but this is in the context of glucagon (IV) overdosage, not beta blocker overdose 2.
From the Research
Treatment Options for Beta Blocker Overdose
The treatment for beta blocker overdose involves various interventions, including:
- Gastric decontamination: Activated charcoal and gastric lavage may be used, but their effectiveness is unclear due to concurrent use of multiple interventions 3
- Catecholamines, inotropes, and vasopressors: These agents may provide a survival benefit and improve hemodynamics 3
- Atropine: May improve heart rate and blood pressure 3
- Calcium: Intravenous calcium may improve hemodynamics, but its effectiveness is unclear due to concurrent use of multiple therapies 3
- High-dose insulin euglycaemic therapy: Associated with mortality benefit and improvement in hemodynamics, but may cause hypoglycemia and hypokalemia 3, 4
- Glucagon: May improve hemodynamics by increasing heart rate 3, 5
- Methylthioninium chloride (methylene blue): May improve hemodynamics, but its effectiveness is unclear due to limited evidence 3
- Intravenous lipid emulsion therapy: Variable response reported, with unclear effectiveness 3
- Lignocaine: May be used to treat arrhythmias secondary to beta blocker toxicity, but its effectiveness is unclear due to limited evidence 3
- Veno-arterial extracorporeal membrane oxygenation: Associated with improved survival in patients with severe cardiogenic shock or cardiac arrest 3, 6
- Dialysis: May assist in the management of massive overdose of specific water-soluble beta blockers, but its effectiveness is unclear due to limited evidence 3
- Pacing: Temporary overdrive cardiac pacing may prevent arrhythmias in sotalol toxicity 3
Key Considerations
When treating beta blocker overdose, it is essential to consider the following:
- Multiple treatments are often used simultaneously, making it challenging to determine the effectiveness of individual interventions 3
- The evidence for treatment recommendations is largely based on low-quality studies and is subject to bias 3
- A graduated response to cardiovascular instability is recommended, starting with intravenous fluids and progressing to more invasive therapies as needed 3