Beta-blocker overdose: Progressive treatment options

Research output: Chapter in Book/Report/Conference proceedingChapter


Beta-adrenergic antagonist agents, routinely known as β-blockers, are commonly prescribed agents for the treatment of cardiac and other diseases. Overdoses of β-blockers are associated with clinical presentations that vary from benign to life-threatening. Basic supportive care and decontamination of the gastrointestinal tract (if the patient presents early) are key in its treatment. Electrolyte replacement and supplemental calcium are important supportive care measures. Some β-blockers can alter the sodium channel, thus increasing the QRS intervals. This disturbance often improves with sodium bicarbonate administration. Other β-blockers may prolong QTc intervals. Both potassium replacement and magnesium administration shorten this interval. Decreases in heart rate and blood pressure commonly seen with β-blockers overdoses are initially treated with intravascular fluid, vasopressor agents (e.g., norepinephrine, epinephrine) and cardiotonic agents (e.g., dobutamine, isoproterenol, milrinone, amrinone, enoximone). Temporary cardiac pacing devices and atropine have also been used to stimulate the bradycardic heart in β-blocker overdoses. The hormone glucagon increases cardiac contractility through β-adrenoceptorindependent mechanisms and is commonly used to improve cardiac function in β-blocker overdoses. High-dose-insulin/euglycemic therapy is also an important therapeutic approach in the bradycardic and hypotensive β-blocker overdosed patient. Case reports support the use of intravenous lipid emulsion in overdoses of lipophilic β-blockers, particularly when combined with calcium channel blocker overdoses. There is limited data supporting the use of methylene blue for refractory shock due to β-blocker overdose. Extracorporeal drug removal by hemodialysis is effective in removing the more hydrophilic β-blockers. Intra-aortic balloon counter pulsation devices, left ventricular assist devices and extracorporeal membrane oxygenation devices have been used to provide heroic mechanical support of arterial blood pressure, heart function, oxygenation, and ventilation in the β-blocker overdosed patient. These patients can present a significant medical challenge and may require multiple medical modalities for successfully treatment.

Original languageEnglish (US)
Title of host publicationBeta-Blockers
Subtitle of host publicationPhysiological, Pharmacological and Therapeutic Implications
PublisherNova Science Publishers, Inc.
Number of pages26
ISBN (Electronic)9781536133127
ISBN (Print)9781536133110
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)


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