Concore AM Overdosage

Symptoms: Symptoms of bisoprolol overdose: The most common signs expected with overdose of a β-blocker are bradycardia, hypotension, bronchospasm, acute cardiac insufficiency and hypoglycemia. There is a wide inter-individual variation in sensitivity and in reactions to one single high dose of bisoprolol and patients with heart failure are probably very sensitive.
Symptoms of amlodipine overdose: Available data suggest that gross overdose could result in excessive peripheral vasodilatation and possibly reflex tachycardia. Marked and probably prolonged systemic hypotension up to and including shock with fatal outcome have been reported.
Non-cardiogenic pulmonary oedema has rarely been reported as a consequence of amlodipine overdose that may manifest with a delayed onset (24-48 hours post-ingestion) and require ventilatory support. Early resuscitative measures (including fluid overload) to maintain perfusion and cardiac output may be precipitating factors.
Management: In general, if overdose occurs, discontinuation of Bisoprolol + Amlodipine (Concore AM) treatment and supportive and symptomatic treatment is recommended including frequent monitoring of cardiac and respiratory function.
Based on the expected pharmacological actions and recommendations for other β-blockers or calcium-antagonists of the dihydropyridine type, the following general measures may be considered when clinically warranted: Bradycardia: Administer intravenous atropine. If the response is inadequate, isoprenaline or another agent with positive chronotropic properties may be given cautiously. Under some circumstances, transvenous pacemaker insertion may be necessary.
Hypotension: Intravenous fluids or vasopressors should be administered. Intravenous glucagon may be useful.
AV block (second or third degree): Patients should be carefully monitored and treated with isoprenaline infusion or temporary pacing.
Acute worsening of heart failure: Administer i.v. diuretics, positive inotropic agents, vasodilating agents.
Bronchospasm: Administer bronchodilator therapy such as isoprenaline, β₂-sympathomimetic drugs and/or theophylline.
Hypoglycemia: Administer i.v. glucose.
Bisoprolol or amlodipine is hardly dialyzable.