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The most commonly used drugs in this group are verapamil (a papaverine derivative), diltiazem (a benzothiazepine derivative) and nifedipine (a dihydropyridine-like substance).
Although these substances are structurally different, they have a similar pharmacological effect and, as their common name implies, prevent the influx of calcium through free calcium channels in the smooth muscle cells of the heart and vessels. Since the influx of calcium is responsible for the conduction in the heart muscle and also facilitates contraction of smooth muscles in both the heart and vessels, calcium channel blockers reduce the force of contraction and heart rate, thus lowering the oxygen demand of the heart muscle.
Symptoms of poisoning
They most affect the cardiovascular system. Common symptoms are a significant drop in blood pressure and a slow heart rate. Hypotension is the result of damage to the heart muscle and relaxation of the vascular muscles. Conductive effects can lead to bradysrhythmia and heart block, and congestive heart failure may develop as a result of loss of vascular tone and damage to the heart muscle. The patient may be lethargic, faint or even confused. Significant hyperglycaemia may occur, which is not so much prognostic as diagnostic. Calcium channel blockers delay the influence of calcium ions into the cells of the beta islets of the pancreas, thus causing excessive insulin secretion.
First aid
Acute poisoning with calcium channel blockers should always be considered life-threatening. Accidental pediatric or suicidal poisoning should be treated in an intensive care unit. As the case reports show, the symptoms of toxicity develop suddenly and are rapid in nature.
See also: Poisoning
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