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dc.contributor.authorWong, Anselm-
dc.contributor.authorHoffman, Robert S-
dc.contributor.authorWalsh, Steven J-
dc.contributor.authorRoberts, Darren M-
dc.contributor.authorGosselin, Sophie-
dc.contributor.authorBunchman, Timothy E-
dc.contributor.authorKebede, Sofia-
dc.contributor.authorLavergne, Valery-
dc.contributor.authorGhannoum, Marc-
dc.identifier.citationClinical Toxicology 2021; 59(5): 361-375en
dc.description.abstractCalcium channel blockers (CCBs) are commonly used to treat conditions such as arterial hypertension and supraventricular dysrhythmias. Poisoning from these drugs can lead to severe morbidity and mortality. We aimed to determine the utility of extracorporeal treatments (ECTRs) in the management of CCB poisoning. We conducted systematic reviews of the literature, screened studies, extracted data, summarized findings, and formulated recommendations following published EXTRIP methods. A total of 83 publications (6 in vitro and 1 animal experiments, 55 case reports or case series, 19 pharmacokinetic studies, 1 cohort study and 1 systematic review) met inclusion criteria regarding the effect of ECTR. Toxicokinetic or pharmacokinetic data were available on 210 patients (including 32 for amlodipine, 20 for diltiazem, and 52 for verapamil). Regardless of the ECTR used, amlodipine, bepridil, diltiazem, felodipine, isradipine, mibefradil, nifedipine, nisoldipine, and verapamil were considered not dialyzable, with variable levels of evidence, while no dialyzability grading was possible for nicardipine and nitrendipine. Data were available for clinical analysis on 78 CCB poisoned patients (including 32 patients for amlodipine, 16 for diltiazem, and 23 for verapamil). Standard care (including high dose insulin euglycemic therapy) was not systematically administered. Clinical data did not suggest an improvement in outcomes with ECTR. Consequently, the EXTRIP workgroup recommends against using ECTR in addition to standard care for patients severely poisoned with either amlodipine, diltiazem or verapamil (strong recommendations, very low quality of the evidence (1D)). There were insufficient clinical data to draft recommendation for other CCBs, although the workgroup acknowledged the low dialyzability from, and lack of biological plausibility for, ECTR. Both dialyzability and clinical data do not support a clinical benefit from ECTRs for CCB poisoning. The EXTRIP workgroup recommends against using extracorporeal methods to enhance the elimination of amlodipine, diltiazem, and verapamil in patients with severe poisoning.en
dc.subjectcalcium channel blockeren
dc.titleExtracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup.en
dc.typeJournal Articleen
dc.identifier.journaltitleClinical Toxicologyen
dc.identifier.affiliationDepartment of Emergency Medicine, McGill University, Montrealen
dc.identifier.affiliationDrug Health Clinical Services, Royal Prince Alfred Hospital, Sydney, NSW, Australiaen
dc.identifier.affiliationDivision of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USAen
dc.identifier.affiliationSt. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australiaen
dc.identifier.affiliationDepartments of Renal Medicine and Transplantation and Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australiaen
dc.identifier.affiliationCentre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australiaen
dc.identifier.affiliationCentre Antipoison du Québec, Quebec, Canadaen
dc.identifier.affiliationMontérégie-Centre Emergency Department, Centre Intégré de Santé et de Services Sociaux (CISSS), Hôpital Charles-Lemoyne, Greenfield Park, QCen
dc.identifier.affiliationDepartment of Emergency Medicine, Division of Medical Toxicology, The Poison Control Center at Children's Hospital of Philadelphia, Einstein Healthcare Network, Philadelphia, PA, USAen
dc.identifier.affiliationChildren's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USAen
dc.identifier.affiliationSchool of Medicine, St. Peter`s Specialized Hospital Poison Center, Addis Ababa University, Addis Ababa, Ethiopiaen
dc.identifier.affiliationResearch Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canadaen
dc.identifier.affiliationVictorian Poisons Information Centreen
dc.identifier.pubmedid33555964-, Anselm Y
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
item.openairecristype Poisons Information Centre-
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