Overdose : מינון יתר

4.9 Overdose
Cases of massive accidental overdoses of Esmolol have occurred. Some of these overdoses have been fatal while others resulted in permanent disability. Bolus doses in the range of 625 mg to 2.5 g (12.5–50 mg/kg) have been fatal.
Symptoms
In case of overdose the following symptoms can occur: severe hypotension, sinus bradycardia, atrioventricular block, heart insufficiency, cardiogenic shock, cardiac arrest, bronchospasm, respiratory insufficiency, loss of consciousness to coma, convulsions, nausea, vomiting, hypoglycemia and hyperkalemia.
Because of the short elimination half-life of Esmolol Amomed 100 mg/10 ml solution for injection (approximately 9 minutes), the first step in the management of toxicity should be to discontinue the administration of the drug. The time taken for symptoms to disappear following overdosing will depend on the amount of Esmolol Amomed 100 mg/10 ml solution for injection administered. This may take longer than the
30 minutes seen with discontinuation at therapeutic dose levels. Artificial respiration may be necessary. Based on the observed clinical effects, the following general measures should also be considered:
Bradycardia: atropine or another anticholinergic drug should be given i.v.. When the bradycardia cannot be treated sufficiently a pacemaker may be necessary.
Bronchospasm: nebulised beta2-sympathomimetics should be given. If this is not sufficient intravenous beta2- sympathomimetics or aminophylline can be considered.
Symptomatic hypotension: fluids and/or pressor agents should be given i.v..
Cardiovascular depression or cardiac shock: diuretics or sympathomimetics can be administered. The dose of sympathomimetics (depending on the symptoms: dobutamine, dopamine, noradrenaline, isoprenaline, etc.) depends on the therapeutic effect.
In case further treatment is necessary, the following agents can be given i.v.: –   Atropine: 0.5–2 mg
–   Inotropic agents
–   Calcium ions