- Bradycardia & hypotension (most common).
- Myocardial depression & cardiogenic shock (severe overdoses).
- Ventricular dysrhythmias (Common with propranolol & acebutolol).
- Others (mental status change, seizure, hypoglycemia, & bronchospasm).
- Co-ingestions of CCB, TCA, & neuroleptics, increases mortality.
- Mostly symptomatic < 2 hrs following ingestion, & nearly all develop symptoms < 6 hrs.
- Delayed toxicity up to 24 hrs after ingestion (Sustained release meds: metoprolol succinate & sotalol).
- Sotalol prolongs the QTc interval & can lead to Torsades de Pointes.
- Carvedilol (associated with edema & toxic epidermal necrolysis).
- IV lipid emulsion therapy for poisoning involving lipophilic medications (eg, propranolol, metoprolol, labetalol).
