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Case Reports
. 2023 Aug 1;10(1):e878.
doi: 10.1002/ams2.878. eCollection 2023 Jan-Dec.

Intoxication with massive doses of amlodipine and candesartan requiring venoarterial extracorporeal membrane oxygenation

Minagawa Yusuke  1 , Yamana Hidetoshi  2 , Tsutsumi Yusuke  2 , Ishigami Koji  2 , Togo Masahito  2 , Yasuda Susumu  2 , Ogura Takayuki  1
Affiliations
Case Reports

Intoxication with massive doses of amlodipine and candesartan requiring venoarterial extracorporeal membrane oxygenation

Minagawa Yusuke et al. Acute Med Surg. .

Abstract

Background: Calcium channel blockers and angiotensin II receptor blockers are commonly prescribed to treat hypertension. Massive overdoses can cause both distributive and cardiogenic shock because of their effects on vascular smooth muscles and severe myocardial depression.

Case presentation: We present the case of a 46-year-old man who was brought to our emergency department after ingesting 1210 mg amlodipine and 936 mg candesartan. The patient's hemodynamic status deteriorated despite treatment with vasopressors, calcium gluconate, and hyperinsulinemia-euglycemia therapy with mechanical ventilation. Venoarterial extracorporeal membrane oxygenation was initiated for refractory shock. The patient was weaned off extracorporeal membrane oxygenation on day 5 and discharged on day 18 of hospitalization.

Conclusion: When medical therapies are ineffective, aggressive venoarterial extracorporeal membrane oxygenation should be considered for the management of refractory shock in the setting of calcium channel blocker with angiotensin II receptor blocker overdose.

Keywords: ECMO; amlodipine; candesartan; drug overdose; toxicity.

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Conflict of interest statement

The authors declare no conflict of Interest.

Figures

FIGURE 1
FIGURE 1
Blood concentrations of amlodipine and candesartan during the clinical course of a 46‐year‐old man with intoxication with massive doses of amlodipine and candesartan. dBP, diastolic blood pressure; ECMO, extracorporeal membrane oxygenation; Lac, lactate; sBP, systolic blood pressure.
See this image and copyright information in PMC

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