A recent retrospective study of calcium channel blocker poisoned patients found that patients with amlodipine poisoning experienced more vasodilation when treated with high-dose insulin (HDI) than those poisoned by of non-dihydropyridines. What is the proposed mechanism?
HDI acts as a vasodilator via enhancement of endothelial nitric oxide synthase (eNOS). Unlike other CCBs, amlodipine also stimulates eNOS to produce nitric oxide (NO). The potential exists, therefore, for HDI to cause synergistic iatrogenic vasodilation when used in the setting of amlodipine poisoning
Cole JB, Lee SC, Prekker ME, Kunzler NM, Considine KA, Driver BE, Puskarich MA, Olives TD. Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: a comparison of amlodipine versus non-dihydropyridines. Clin Toxicol (Phila). 2022 Nov;60(11):1205-1213. doi: 10.1080/15563650.2022.2131565. Epub 2022 Oct 25. PMID: 36282196.