There is no information on overdose with Metoprolol tartrate + Ivabradine (Implicor) in humans.
Symptoms: Linked to ivabradine: Overdose may lead to severe and prolonged bradycardia.
Linked to metoprolol: Poisoning due to an overdose of metoprolol may lead to severe hypotension, sinus bradycardia, atrioventricular block, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, impairment of consciousness, coma, nausea, vomiting and cyanosis.
Symptoms may worsen, if using alcohol, blood pressure medicine, quinidines or barbiturates simultaneously.
The first manifestations usually appear 20 minutes to two hours after drug ingestion.
Management: In addition to general measures (e.g. gastric lavage which could be considered within 4 hours after ingestion and in case of serious intoxication, active charcoal) patients should be transferred to an intensive care setting, where vital parameters can be monitored and, if necessary, corrected.
Severe bradycardia should be treated symptomatically. In the event of bradycardia with poor hemodynamic tolerance, symptomatic treatment including intravenous beta-stimulating medicinal products such as isoprenaline may be considered. Temporary cardiac electrical pacing may be instituted if required.
Potential antidotes to metoprolol include Orciprenaline (0.5-1 mg) i.v., Atropine 0.5 to 2 mg i.v. and initially Glucagon 1-5 mg (max. 10 mg) i.v. In addition, beta sympathomimetic agents may be given, with exact doses depending upon body weight and effect (e.g. Dobutamine, Isoprenaline, Orciprenaline, and Adrenaline). Dosage may need to be above recommended therapeutic levels. Slow intravenous administration of Diazepam is advised in the event of seizures.