The use of sustained-release and second-generation dihydropyridine CCB preparations is now widespread. 1 These preparations provide a larger drug dose per tablet (especially in children), can extend the duration of clinical toxicity, and can lead to a delay in clinical manifestation of toxicity. Drawing from available case reports that provide plasma drug levels, several management guidelines can be asserted for overdose of any long-acting CCB preparation. First, if significant toxicity occurs, it will be manifested within 6 h of overdose7 although a 12-h delay in overt toxicity after a sustained-release verapamil overdose treated with charcoal administration has been reported.8 Peak drug levels and associated toxicity will occur within 12 h of overdose. Finally, chronic use of the drug will worsen and prolong toxicity of acute overdose.
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