Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers

Abstract

Intravenous lipid emulsion may be ineffective in acute poisonings with amlodipine, nifedipine or metoprolol.

Lipid emulsion attenuates extrinsic apoptosis induced by amlodipine toxicity in rat cardiomyoblasts

“…7,8 However, some case reports have suggested that lipid emulsion may have no effect on cardiovascular collapse induced by amlodipine toxicity. 9,10 Overall, the conclusions on lipid emulsion treatment for amlodipine toxicity are conflicting. 2 –5,9,10 Amlodipine toxicity results in a negative inotropic effect and bradycardia in isolated heart preparation, and apoptosis in uveal malignant melanoma and human fibroblasts.…”

“…9,10 Overall, the conclusions on lipid emulsion treatment for amlodipine toxicity are conflicting. 2 –5,9,10 Amlodipine toxicity results in a negative inotropic effect and bradycardia in isolated heart preparation, and apoptosis in uveal malignant melanoma and human fibroblasts. 11 –14 A previous study showed that lipid emulsion attenuated apoptosis in cardiomyoblasts induced by the phenylalkylamine calcium channel blocker verapamil at toxic doses.…”

Successful usage of intravenous lipid emulsion in treatment of acute verapamil poisoning: A case report

“…There were rare case reports in which ILE was not effective. For example, in polydrug poisoning with prevailing effects of amlodipine or nifedipine, fatal outcomes due to respiratory and cardiocirculatory shock occurred despite the use of ILE 15 . However, other drugs probably contributed to the severity of poisoning in described cases and to the failure of ILE therapy.…”

A case report on the effect of plasmapheresis in the treatment of severe calcium channel blocker toxicity

“…However, ILE was not always superior to standard treatment protocols in attenuating toxicity of some other drugs, including CBBs. (13) Lipid emulsion was associated with improved hemodynamic parameters and survival in animal models of intravenous verapamil poisoning, but not in models of oral verapamil poisoning. (4) The evidence for the use of ILE in calcium channel blocker overdose is weak, coming mainly from animal studies and human case reports.…”

“…Although intravenous lipid emulsion may be life-saving treatment of poisonings with certain calcium channel blockers or beta blockers, like verapamil and propranolol, it may be ineffective in some other circumstances, including toxicity of amlodipine, nifedipine and metoprolol. (13) There are possible problems associated with the use of ILE, including respiratory distress and the inability to measure serum electrolytes. In one case report, adverse effects such as hypertriglyceridemia and hypoxemia were observed with lipid emulsion when used at exceptionally high doses.…”