Reactions 1350 - 7 May 2011

O SVerapamil/trandolapril overdose

Bradycardia and hypotension: case reportA 60-year-old man developed bradycardia and

hypotension after an accidental verapamil/trandolapriloverdose.

The man presented with dizziness approximately 8 hoursafter ingesting five tablets of extended-release verapamil/trandolapril [Tarka; amount ingested not clearly stated].Verapamil/trandolapril had been prescribed to him at adosage of 240/4mg daily for hypertension. He had inducedemesis upon realising the mistaken ingestion; however, hehad became increasingly dizzy and would collapse onstanding. Upon arrival at the emergency department, his BPand HR were 61/35mm Hg and 52 bpm, respectively. Hewas fatigued, dizzy and had a weak dorsalis pedis pulse.His blood urea nitrogen and serum creatinine levels wereelevated.

Treatment with sodium chloride, calcium chloride andinsulin was initiated; however, calcium chloride waswithdrawn due to the onset of vomiting. Glucagon, calciumgluconate and charcoal were also introduced. His vomitingpersisted and glucagon was withdrawn. Dopamine wasstarted with a subsequent improvement in his BP. He wastransferred to the cardiac ICU where dopamine and insulinwere withdrawn. Approximately 17 hours postingestion,his BP and HR were 116/66mm Hg and 55 bpm,respectively. Serial ECGs revealed sinus bradycardia with aright bundle branch block. All concomitant medicationswere restarted, with the exception of verapamil/trandolapril. He was discharged approximately 48 hoursafter ingestion without sequelae.

Author comment: "Based on the Naranjo adverse drugreaction probability scale, this verapamil and trandolaprilcombination product-induced hypotension and bradycardiawas considered probable and secondary to the accidentalingestion of multiple tablets of the fixed-dose combinationproduct, Tarka."Cohen V, et al. Tarka (trandolapril/verapamil hydrochloride extended-release)overdose. Journal of Emergency Medicine 40: 291-295, No. 3, Mar 2011.Available from: URL: http://dx.doi.org/10.1016/j.jemermed.2008.10.015 -USA 803053408

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Reactions 7 May 2011 No. 13500114-9954/10/1350-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved