Should I administer Calcium to prevent hypotension when giving CCB in the ED?

2 Jul

There are several studies regarding this matter, and they reveal conflicting results:

  • One study was done on elderly patients in PSVT10 patients received IV Verapamil, 7 patients received IV Calcium prior to Verapamil.  Blood pressure fell in both groups, but in the group receiving Ca the BP returned to baseline in 5 minutes and the % decrease of the BP was significantly lower in the group receiving calcium.  Changes in the heart rate were identical in each group.
  • Another study in 1987 involved 16 patients being treated for multifactorial atrial tachycardia.  5 received a IV calcium prior to Verapamil, the other 11 did not.  HR decreased by 27% with calcium vs. 19% without.  BP decreased by 11% with calcium and 27% without.
  • Study in 2004 with 450 patients was unable to find a statistically significant blunting of drop in SBP with CaCl pre-treatment prior to diltiazem administration in the setting of Afib/flutter w/ RVR.

Submitted by W. Brooks.

Reference(s): Intravenous verapamil for treatment of multifocal atrial tachycardia with and without calcium pretreatment, Salerno, et al, Ann Intern Med. 1987 Nov;107(5):623-8.; Calcium chloride before i.v. diltiazem in the management of atrial fibrillation, Kolkebeck, et al, J Emerg Med. 2004 May;26(4):395-400.; picture


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