목적: 칼슘 통로 차단제는 흔히 사용되는 항고혈압 약제이다. 전세계적으로 사용량 증가에 따른 과량 복용에 대한 보고가 증가 하고 있지만 국내 보고는 미흡하다. 칼슘 통로 차단제 중 암로디핀은 매우 흔히 사용되는 약제이나 과량복용에 대해서는 임상의에게는 익숙하지 않다. 따라서 본 연구는 암로디핀을 과다 복용한 환자들의 임상양상, 치료 경과, 합병증 및 예후에 대해 조사하였다. 방법: 2002년 1월부터 2010년 12월까지 순천향대학교 천안병원에 약물중독으로 내원한 환자 중 암로디핀을 과량 복용한 환자를 대상으로 후향적 조사를 하였다. 약물 복용량은 환자나 보호자 진술에 근거하여 체표면적당 약물 복용량(Billy’s BSA formula)으로 계산하였고, 응급실 내원 당시의 초기 생징후, 혈액 검사, 심전도 검사 등을 조사하였으며, 심전도 이상은 서맥, 방실 전도장애, QT, QRS 간격의 증가 중 1개 이상의 변화가 있을 경우로 정의하였다. 결과: 총 9명의 환자(남자 2명, 여자 7명)가 포함되었고, 체표면적당 암로디핀 복용량은 197.78 ± 128.37 mg이었으며, 모든 환자에서 다른 종류의 약물을 같이 과량 복용했다. 9명의 환자 중 2명이 사망했고, 사망한 환자의 체표면적당 약물 복용량은 343.5 mg/m2와 225.6 mg/m2이었고, 생존 환자 모두에서는 200 mg/m2 이하였다. 3명의 환자에서 glimepride를 같이 과량 복용했지만, 200 mg/dL 이상의 혈당 수치를 보였고, 이 중에서 1명은 고혈당이 조절되지 않아 대사성 케톤산증이 진행되어 다장기 부전으로 사망하였다. 심전도 이상을 보인 환자의 평균 체표면적당 약물 복용량은 197.1 ± 92.3 mg/m2이었고, 심전도 이상이 없는 환자에서는 58.5 ± 27.1 mg/m2이었다. 결론: 비교적 안전하다고 알려진 non-dihydropyridine계인 암로디핀도 과량 복용 시 고혈당과 대사성 케톤산증 및 심장 전도 이상이 유발되어 치명적인 결과를 보일 수 있다. 고혈당 발생은 나쁜 예후를 시사하므로 이에 대한 주의가 필요하다.

Background/Aims:Calcium channel blockers (CCBs) are anti-hypertensive medications that are used worldwide. CCB overdose has increased in proportion to the use of these drugs. Although amlodipine is the most widely used CCB, many physicians are not familiar with amlodipine overdose. We report the clinical outcome in patients with an intentional amlodipine overdose. Methods: We retrospectively reviewed the medical records of the patients who visited Soonchunhyang University Cheonan Hospital with an amlodipine overdose from January 2002 through December 2010. We recorded the initial vital signs, blood chemistry, electrocardiography, and estimated amount of amlodipine ingested. Results:Nine patients were enrolled, of whom two patients died. Both patients who died had ingested more than 200 mg/m2 of amlodipine, while all of the patients who ingested less than 200 mg/m2 of amlodipine survived. Three patients had blood sugar levels exceeding 200 mg/dL and two of these died despite high-dose insulin therapy in combination with glucose infusion (hyperinsulinemia/euglycemia therapy). Although three patients also took a glimepiride overdose, none had hypoglycemia. The amount of amlodipine ingested relative to the body surfaced area (BSA) was 197.1 ± 92.3 mg/m2 in patients with an abnormal ECG and 58.5 ± 27.1 mg/m2 in patients with a normal ECG. Conclusions:Amlodipine overdose can induce hyperglycemia, resulting in lethal cardiogenic shock owing to the decreased calcium influx, inappropriate energy production, and weakened inotropic effect. Therefore, amlodipine-induced hyperglycemia indicates a poor prognosis. (Korean J Med 2011;81:208-214)

Background/Aims:Calcium channel blockers (CCBs) are anti-hypertensive medications that are used worldwide. CCB overdose has increased in proportion to the use of these drugs. Although amlodipine is the most widely used CCB, many physicians are not familiar with amlodipine overdose. We report the clinical outcome in patients with an intentional amlodipine overdose. Methods: We retrospectively reviewed the medical records of the patients who visited Soonchunhyang University Cheonan Hospital with an amlodipine overdose from January 2002 through December 2010. We recorded the initial vital signs, blood chemistry, electrocardiography, and estimated amount of amlodipine ingested. Results:Nine patients were enrolled, of whom two patients died. Both patients who died had ingested more than 200 mg/m2 of amlodipine, while all of the patients who ingested less than 200 mg/m2 of amlodipine survived. Three patients had blood sugar levels exceeding 200 mg/dL and two of these died despite high-dose insulin therapy in combination with glucose infusion (hyperinsulinemia/euglycemia therapy). Although three patients also took a glimepiride overdose, none had hypoglycemia. The amount of amlodipine ingested relative to the body surfaced area (BSA) was 197.1 ± 92.3 mg/m2 in patients with an abnormal ECG and 58.5 ± 27.1 mg/m2 in patients with a normal ECG. Conclusions:Amlodipine overdose can induce hyperglycemia, resulting in lethal cardiogenic shock owing to the decreased calcium influx, inappropriate energy production, and weakened inotropic effect. Therefore, amlodipine-induced hyperglycemia indicates a poor prognosis. (Korean J Med 2011;81:208-214)

Amlodipine; Overdose; Hyperglycemia