Management overview for beta-blocker poisoning

Beta blockers are heterogeneous in poisoning. Propranolol and sotalol are the most toxic. Propranolol can cause coma and seizures, particularly in severe poisoning, as well as QRS widening and sodium channel blockade. Sotalol can cause QT-interval prolongation. Other oral beta blockers include atenolol, bisoprolol, carvedilol, labetalol, metoprolol, nebivolol, oxprenolol and pindolol, which are relatively less toxic. Metoprolol is available as both immediate-release and modified-release preparations.

Co-ingestion with other cardiovascular drugs (eg calcium channel blockers, digoxin, angiotensin converting enzyme inhibitors) increases the potential for severe cardiovascular toxicity.

If beta-blocker poisoning is suspected, urgently contact a clinical toxicologist or poisons information centre (13 11 26). If the patient is symptomatic, seek advice early from a clinical toxicologist.

Management priorities for beta-blocker poisoning are to maintain adequate circulation and, if poisoning is severe, provide early gastrointestinal decontamination with activated charcoal. Bedside echocardiography can help to assess ventricular function and guide therapy. Coma and seizures require early intervention.