Pharmacotherapy Management of Beta-Blocker Toxicity in the Emergency Department

Beta-blocker (BB) overdose presentations to the emergency department represent a significant contributor to cardiovascular toxic exposures and associated morbidity and mortality. Overdose is characterized primarily by bradycardia, hypotension, atrioventricular blockade, and cardiogenic shock, alongside potential central nervous system depression. The severity of clinical manifestations is influenced by agent-specific pharmacologic properties, formulation (e.g., extended-release), and dose. Specific therapies discussed include atropine, glucagon, hyperinsulinemic euglycemia therapy, intravenous lipid emulsion, methylene blue, and extracorporeal treatments such as hemodialysis and extracorporeal membrane oxygenation. BB overdose requires prompt recognition in the emergency department and a tiered therapeutic approach tailored to the severity of presentation and specific agent involved. While foundational interventions remain vital, adjunctive therapies such as hyperinsulinemic euglycemia therapy and methylene blue offer mechanistically distinct options that may improve outcomes in refractory cases. Further studies are warranted to clarify optimal treatment sequencing, comparative efficacy, and long-term outcomes in BB toxicity.