Verapamil is a calcium channel blocker (CCB) that can cause serious adverse effects in an overdose. It shows high protein binding and a high volume of distribution. Currently there is no specific antidote if too much is ingested.
Patient selection: overdose of verapamil
Clinical features:
(1) hypotension
(2) bradycardia
(3) metabolic acidosis
(4) hyperglycemia
If a sustained-release formulation is taken, then the symptoms may be prolonged for several days.
Therapy is supportive with infusions of inotropes, glucagon and calcium gluconate. Severe cases may be treated with cardiac pacing and/or extracorporeal membrane oxygenation (ECMO) and/or plasmapheresis.
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