Life-saving treatments for patients experiencing a drug overdose are important fields to participate for hospital pharmacists. In this study, we described the therapeutic and pharmacokinetic considerations for the lifesaving treatment of a 71-year-old female patient who ingested at once 25 sustained-release capsules of diltiazem hydrochloride (Herbessor R 100mg), which is widely used for the treatment of angina pectoris and hypertension. The administrations of norepinephrine, dopamine and isoproterenol proved to be useful in overcoming the acute symptoms of poisoning by diltiazem, while the administration of calcium gluconate was effective in bringing the patient back to life just before falling into atrioventricular block. Except for periods of strong cardiotonic therapy, the plasma diltiazem concentrations correlated with multiplying products by the heart rate and blood pressure, and well reflected the transit of hemodynamics. Plasma exchange therapy in this patient after receiving high doses of catecholamines provided a rapid recovery from symptoms of anuria, and the plasma diltiazem concentration also rapidly decreased. This phenomenon might be due to the rapid and effective removal of catecholamines remaining in the circulation by the plasma exchange therapy. Although direct hemoperfusion and continuous hemodiafiltration did not seem to remove the plasma diltiazem effectively, these therapeutic methods were useful in removing uremic toxins while the patient's renal function was slowed. Using gastrointestinal lavage and activated charcoal administration together, an immediate recovery from the symptoms of poisoning due to a diltiazem overdose would be obtained.
