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  • 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).


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