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Hutson P, Guieu R, Deharo JC, Michelet P, Brignole M, Vander Ark C, Hamdan MH. Safety, Pharmacokinetic, and Pharmacodynamic Study of a Sublingual Formula for the Treatment of Vasovagal Syncope. Drugs R D 2022; 22:61-70. [PMID: 35150431 PMCID: PMC8885938 DOI: 10.1007/s40268-021-00378-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background Vasovagal syncope is a common cause of syncope which, if recurrent, can have multiple negative consequences such as injury and occupational disability. Various medications can be used to decrease the recurrence of vasovagal syncope but there are no drugs that can be used by patients to interrupt a perceived vasovagal episode. Methods A phase I study was performed to evaluate the tolerability and safety of a gel formulation containing capsaicin (1 mg), phenylephrine HCL (PE) and caffeine citrate (200 mg) (CPC) in normal adult volunteers. Secondary objectives were to characterize the pharmacokinetics (PK) of the CPC formulation and the highest dose of PE needed to achieve a target increase in systolic BP of at least 40 mmHg. After receiving the first dose, a second dose of the CPC mixture was administered at 2 h. Suboptimal changes in systolic blood pressure (SBP) were noted at PE doses of 0.6, 1.2, and 1.8 mg, therefore a second cohort was studied at PE doses of 10, 20, and 30 mg. Blood samples were collected in rapid sequence and were assayed for all three drugs. Results A total of 17 subjects received the drug with no serious adverse effects reported. All doses were well tolerated, although the capsaicin content usually caused expected temporary oral and gastric discomfort. One subject did not complete the study because of a vasovagal reaction that was associated with the frequent blood sampling. There was a 5–25 min lag in the appearance of measurable blood concentrations of capsaicin and phenylephrine. Most subjects had baseline caffeine concentrations from dietary use, with a gradual increase noted after 15 min consistent with GI absorption. Although the intended criterion of a 40 mmHg increase in SBP was not reached, a clinically significant increase in BP for at least 15 min was noted in the six subjects who received the highest dose of PE (30 mg), with a gradual decline over the next 2 h. Conclusion The ternary mixture of capsaicin, phenylephrine, and caffeine was well tolerated when administered as two sublingual/oral doses over a 2-h period.
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Affiliation(s)
- Paul Hutson
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53705, USA.
| | - Regis Guieu
- Assistance Publique, Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France.,Aix Marseille Université, C2VN, Marseille, France
| | - Jean-Claude Deharo
- Assistance Publique, Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France.,Aix Marseille Université, C2VN, Marseille, France
| | - Pierre Michelet
- Assistance Publique, Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France.,Aix Marseille Université, C2VN, Marseille, France
| | - Michele Brignole
- IRCCS, Istituto Auxologico Italiano, Faint and Fall Programme, Cardiology Unit and Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Cassondra Vander Ark
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Mohamed H Hamdan
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792, USA
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Boutou E, Virgiliou C, Seliniotaki AK, Lithoxopoulou M, Mataftsi A, Ziakas N, Diamanti E, Raikos N, Gika H. A hydrophilic interaction liquid chromatography - Tandem mass spectrometry method for the determination of phenylephrine in dried blood spots from preterm infants. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1190:123084. [PMID: 35032892 DOI: 10.1016/j.jchromb.2021.123084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/17/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
A sensitive and accurate hydrophilic interaction liquid chromatography - tandem mass spectrometry method (HILIC-MS/MS) was developed and validated for the determination of phenylephrine concentration in Dried Blood Spot (DBS) samples from preterm infants, after ocular administration of an ophthalmic solution with phenylephrine. Sample preparation involved the extraction of the analyte from an 85 μL DBS sample with methanol - acetonitrile (50:50, v/v). Chromatographic separation was achieved on an ACQUITY UPLC BEH AMIDE column, under isocratic conditions within a 5 min run. Detection was achieved with a triple quadrupole MS applying electrospray ionization in positive mode. The method was fully validated and proved precise and accurate with in a linear range of 0.59-3.53 ng/ml in blood. The method was developed to provide insights on the level of exposure of infant population to phenylephrine after ocular administration.
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Affiliation(s)
- E Boutou
- Department of Chemistry, Aristotle University of Thessaloniki, Greece
| | - C Virgiliou
- Department of Chemistry, Aristotle University of Thessaloniki, Greece
| | - A K Seliniotaki
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Lithoxopoulou
- 2nd Department of Neonatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Mataftsi
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Ziakas
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Diamanti
- 2nd Department of Neonatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Raikos
- Laboratory of Forensic Medicine & Toxicology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - H Gika
- Laboratory of Forensic Medicine & Toxicology, School of Medicine, Aristotle University of Thessaloniki, Greece.
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Christensen LK, Armstead VE, Bilyeu DP, Johnson KE, Friesen RH. Hemodynamic responses and plasma phenylephrine concentrations associated with intranasal phenylephrine in children. Paediatr Anaesth 2017; 27:768-773. [PMID: 28504321 DOI: 10.1111/pan.13168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intranasal phenylephrine, an alpha-1 adrenergic agonist, causes vasoconstriction of the nasal mucosa and is used to reduce bleeding associated with nasotracheal intubation or endoscopic sinus surgery. The purpose of this study was to describe the hemodynamic effects associated with plasma phenylephrine concentrations following topical intranasal administration of 0.25% and 0.5% phenylephrine in children. METHODS After Institutional Review Board and parental approval, 77 children between the ages of 2 and 12 years were studied in a prospective, double-blind manner and randomized into three groups. Group 1 received intranasal saline, while groups 2 and 3 received 0.1 mL/kg of 0.25% or 0.5% phenylephrine, respectively. All received the same anesthetic of halothane, N2 O, O2 , and vecuronium. After inhalation induction, endtidal halothane and PaCO2 were maintained at 1.5% and 35 mm Hg, respectively. Heart rate and rhythm, systolic, diastolic, and mean, noninvasive arterial blood pressures were recorded and venous blood was obtained for measurement of plasma phenylephrine concentration by high-performance liquid chromatography at baseline and at 2, 5, 10, and 20 minutes following intranasal spray application of the study drug. Nasotracheal intubation was performed immediately following the 5-minute measurements, and the presence of bleeding was assessed. Hemodynamic data were compared by analysis of variance for repeated measures. Bleeding and arrhythmia incidence among groups were analyzed using chi-squared tests. Phenylephrine levels were correlated with hemodynamic values via regression analysis. RESULTS Fifty-two patients received intranasal phenylephrine. Increases in blood pressure correlated with increasing plasma phenylephrine concentration. Systolic blood pressure increased 8%, and mean blood pressure increased 14%, which were statistically significant but clinically insignificant. Heart rate did not change, and the incidence of arrhythmia was low and similar among groups. Bleeding following nasotracheal intubation was less frequent in Group 3 (11/27 subjects) than in Group 1 (17/25). Peak plasma phenylephrine concentrations were observed by 14±7 minutes following intranasal administration, and were highly variable among individuals (37.8±39.7 and 49.6±93.9 ng/mL [mean±SD] in Groups 2 and 3). DISCUSSION Administration of intranasal phenylephrine, 0.25% and 0.50%, results in rapid but highly variable systemic absorption that is associated with mild increases of blood pressure that are clinically insignificant. Bleeding associated with nasotracheal intubation was less following administration of 0.5% intranasal phenylephrine than following intranasal saline.
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Affiliation(s)
- Lisa K Christensen
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
| | - Valerie E Armstead
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
| | - David P Bilyeu
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
| | - Kenneth E Johnson
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
| | - Robert H Friesen
- Departments of Anesthesiology and Pharmacology, Children's Hospital Colorado, University of Colorado Schools of Medicine and Pharmacy, Denver, CO, USA
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Meltzer EO, Ratner PH, McGraw T. Oral Phenylephrine HCl for Nasal Congestion in Seasonal Allergic Rhinitis: A Randomized, Open-label, Placebo-controlled Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:702-8. [PMID: 26143019 DOI: 10.1016/j.jaip.2015.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/29/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Phenylephrine hydrochloride (PE HCl) is widely used for the treatment of nasal congestion, but efficacy at the 10-mg dose is not known for certain. The Food and Drug Administration has requested that sufficiently powered, multicenter, dose-ranging studies be conducted to assess the efficacy and safety of PE HCl. OBJECTIVE To evaluate subjective nasal congestion symptom relief and safety of 4 different doses of PE HCl immediate-release 10-mg tablets and placebo in adults with seasonal allergic rhinitis (SAR). METHODS This multicenter, phase 2, parallel, open-label trial randomized 539 adults with SAR (but otherwise healthy) to 7 days of treatment with either PE HCl 10-mg tablets at fixed doses of 10, 20, 30, or 40 mg or placebo. The primary efficacy end point was the mean change from baseline over the entire treatment period in daily reflective nasal congestion score. Other efficacy end points and safety were also evaluated. RESULTS None of the PE HCl treatment groups had a statistically significant change from baseline in instantaneous or reflective nasal congestion scores compared with the placebo group. PE HCl was well tolerated at doses of up to 30 mg. At least 1 treatment-emergent adverse event was experienced by 18.4% of the participants, the most common being headache (3.0%). CONCLUSIONS PE HCl, at doses of up to 40 mg every 4 hours, is not significantly better than placebo at relieving nasal congestion in adults with SAR. The phenylephrine section of the Food and Drug Administration monograph on over-the-counter cold, cough, allergy, bronchodilator, and antiasthmatic products should be revised accordingly.
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Affiliation(s)
- Eli O Meltzer
- Allergy & Asthma Medical Group & Research Center, San Diego, Calif
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Janin A, Monnet J. Bioavailability of paracetamol, phenylephrine hydrochloride and guaifenesin in a fixed-combination syrup versus an oral reference product. J Int Med Res 2014; 42:347-59. [PMID: 24553480 DOI: 10.1177/0300060513503762] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to compare the bioavailability of paracetamol, phenylephrine hydrochloride and guaifenesin in a new oral syrup with an established oral reference product. The secondary objective was to compare the safety of the new syrup and the reference product. METHODS This was a single-centre, open-label, randomized, reference-replicated, crossover study. Healthy adult volunteers received one dose of syrup and two separate doses of a reference oral liquid formulation in a randomized sequence over three study periods, with a washout interval of ≥ 7 days between study periods. Blood samples were taken regularly postdose and analysed for paracetamol, phenylephrine hydrochloride and guaifenesin concentrations; adverse events were recorded. RESULTS This study enrolled 45 subjects. For paracetamol and guaifenesin, the syrup and reference product were considered to be bioequivalent. Bioequivalence was not shown for phenylephrine hydrochloride. All adverse events were mild or moderate, most of which were considered formulation related. CONCLUSIONS The syrup did not reach bioequivalence with the reference product, as bioequivalence could not be shown for phenylephrine hydrochloride. This may be due to differences in the excipients between the two products. Both the syrup and the reference product had a good safety profile and were well tolerated.
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Affiliation(s)
- Annick Janin
- Novartis Consumer Health S.A., Nyon, Switzerland
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Freestone PP, Hirst RA, Sandrini SM, Sharaff F, Fry H, Hyman S, O'Callaghan C. Pseudomonas aeruginosa -Catecholamine Inotrope Interactions. Chest 2012; 142:1200-1210. [DOI: 10.1378/chest.11-2614] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Affiliation(s)
- Isadore Kanfer
- School of Pharmaceutical Sciences, Rhodes University, Grahamstown, South Africa
| | - Roslind Dowse
- School of Pharmaceutical Sciences, Rhodes University, Grahamstown, South Africa
| | - Vusumuzi Vuma
- School of Pharmaceutical Sciences, Rhodes University, Grahamstown, South Africa
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In-vitro hypocoagulability on whole blood thromboelastometry associated with in-vivo expansion of red cell mass in an equine model. Blood Coagul Fibrinolysis 2011; 22:424-30. [PMID: 21508831 DOI: 10.1097/mbc.0b013e3283464f83] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In several species, there is a strong correlation between indicators of red cell mass (RCM) and thromboelastometry results. The horse has a reliable, temporary, polycythemia in response to phenylephrine infusion. Our objective was to evaluate the effects of an in-vivo increase in circulating RCM on thromboelastometry results in an equine model of transient polycythemia. Six healthy research horses had whole blood thromboelastometry with contact activator and tissue factor initiation after recalcification of citrated samples. Additional samples were frozen for thrombin-antithrombin (TAT). Complete blood count biochemical analysis, fibrinogen, activated partial thromboplastin time (aPTT), and prothrombin time (PT) were performed. Additional samples were taken at 5 min and 2 h after phenylephrine infusion. Thromboelastometry was performed separately on four horses not receiving phenylephrine with the samples divided and spiked with phenylephrine ex vivo. Red cell count (P<0.001) and hematocrit (P<0.001) were significantly higher at 5 min after phenylephrine compared with baseline and 2 h. There was no change in platelet count, fibrinogen, PT, aPTT, or TAT at any time point. Both ex-tem and in-tem parameters were hypocoagulable at 5 min after phenylephrine compared to baseline and 2 h. There was no effect of phenylephrine in the ex-vivo spiking studies on any of the thromboelastometry parameters. Whole blood thromboelastometry results were hypocoagulable in this equine model of in-vivo transient polycythemia only during the polycythemic phase. All other coagulation parameters were unchanged. In the absence of other indicators of hypocoagulability, this may point to an artifact of thromboelastometry. Alternatively, the data may reflect true in-vivo hypocoagulability in patients with increased circulating RCM.
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Galmier MJ, Frasey AM, Meski S, Beyssac E, Petit J, Aiache JM, Lartigue C. High-performance liquid chromatographic determination of phenylephrine and tropicamide in human aqueous humor. Biomed Chromatogr 2000; 14:202-4. [PMID: 10850625 DOI: 10.1002/1099-0801(200005)14:3<202::aid-bmc943>3.0.co;2-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A high-performance liquid chromatographic method for the simultaneous determination of phenylephrine and tropicamide in human aqueous humor was developed. After centrifugation, an aliquot of the supernatant was injected onto the column and the eluent was monitored at 280 nm then 254 nm after 5 min. Separation was performed on a CN column with 0.01 M Pic B8 (octane sulfonic acid)-acetonitrile (65:35, v/v) as mobile phase. The standard curves were linear in the detection range. The precision of the method (expressed by relative standard deviation) and the accuracy (mean error in per cent) were <5% for both intra- and interassays.
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Affiliation(s)
- M J Galmier
- Groupe de Recherche en Biodynamique du Médicament, Laboratoire de Chimie Analytique et de Spectrométrie de Masse, Faculté de Pharmacie, Clermont-Ferrand, France
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Vuma V, Kanfer I. High-performance liquid chromatographic determination of phenylephrine in human serum with coulometric detection. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL APPLICATIONS 1996; 678:245-52. [PMID: 8738028 DOI: 10.1016/0378-4347(95)00487-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A high-performance liquid chromatographic method for the determination of phenylephrine (PE) in human serum using coulometric detection is described. PE and internal standard, orciprenaline, were extracted from serum by solid-phase extraction and separation achieved on a coupled column system consisting of two C18 cartridge columns (250 x 4.6 mm I.D. coupled to a shorter 50 x 4.6 mm I.D. column) using a mobile phase of methanol-50 mM phosphate buffer (pH 3.2; 10:90) at 36 degrees C. Dual electrode coulometric detection was used in the "oxidative screen" mode. Calibration curves were linear over the range 0.3-4 ng/ml with a limit of quantification (LOQ) of 0.35 ng/ml. The method has a greater degree of sensitivity, precision and accuracy compared to previously published methods for PE and is suitable for use in pharmacokinetic and bioequivalence studies in humans.
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Affiliation(s)
- V Vuma
- Biopharmaceutics Research Institute, School of Pharmaceutical Sciences, Rhodes University, Grahamstown, South Africa
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12
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Yamaguchi M, Monji H, Aoki I, Yashiki T. High-performance liquid chromatographic determination of phenylephrine in human serum using column switching with fluorescence detection. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL APPLICATIONS 1994; 661:93-9. [PMID: 7866557 DOI: 10.1016/0378-4347(94)00330-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A method for the determination of total phenylephrine (free plus conjugated) in human serum was developed using column-switching high-performance liquid chromatography (HPLC) with fluorescence detection. After serum was deproteinized with acetonitrile, the conjugated phenylephrine was hydrolyzed with diluted hydrochloric acid. The solution was evaporated to dryness. The reconstituted residue was analyzed with HPLC using a heart-cut technique. Good recoveries of the analytes from spiked human serum samples were obtained with small coefficients of variation. A good linear response was obtained for the concentration range 5-500 ng/ml. The lower limit of quantitation for phenylephrine in human serum was 5 ng/ml. The method was applied to the determination of phenylephrine in human serum after oral administration of phenylephrine hydrochloride.
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Affiliation(s)
- M Yamaguchi
- Takeda Analytical Research Laboratories, Osaka, Japan
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Landzberg JS, Parker JD, Gauthier DF, Colucci WS. Effects of myocardial alpha 1-adrenergic receptor stimulation and blockade on contractility in humans. Circulation 1991; 84:1608-14. [PMID: 1655303 DOI: 10.1161/01.cir.84.4.1608] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although alpha-adrenergic receptors are present in both normal and failing human left ventricular myocardium and mediate a positive inotropic effect in several other species, it is not known whether stimulation of myocardial alpha-adrenergic receptors exerts a positive inotropic effect or contributes to basal contractile state in vivo in humans. METHODS AND RESULTS We studied 15 patients with angiographically normal coronary arteries (seven with normal left ventricular function and eight with left ventricular failure). To avoid the confounding effects of changes in ventricular loading conditions and systemic reflex mechanisms, the alpha-adrenergic receptor-selective antagonist phentolamine and agonist phenylephrine were infused directly into the left main coronary artery, and the change in contractile state was assessed by measuring left ventricular peak (+)dP/dt. Phentolamine alone had no effect on left ventricular contractility. Phenylephrine exerted a concentration-related positive inotropic effect in patients with normal as well as those with failing ventricles. The alpha-adrenergic effect of phenylephrine, defined as the component blocked by phentolamine, was significantly less in patients with ventricular failure (108 +/- 28 mm Hg/sec) than in normal subjects (248 +/- 54 mm Hg/sec; p less than 0.03). CONCLUSIONS Myocardial alpha-adrenergic receptors do not contribute to the maintenance of basal left ventricular contractile state in humans. However, stimulation of myocardial alpha-adrenergic receptors exerts a positive inotropic effect, the magnitude of which may be attenuated in patients with heart failure.
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Affiliation(s)
- J S Landzberg
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
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Bonfiglio MF, Dasta JF, Gregory JS, Townsend MC, Reilley TE, Flancbaum L. High-dose phenylephrine infusion in the hemodynamic support of septic shock. DICP : THE ANNALS OF PHARMACOTHERAPY 1990; 24:936-9. [PMID: 2244407 DOI: 10.1177/106002809002401005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 75-year-old man with hyperdynamic septic shock and vasodilation was successfully supported hemodynamically for 88.5 hours through the use of a continuous infusion of phenylephrine at dosages up to 360 micrograms/min. The only other vasoactive compound administered was dopamine at a dosage of 3.4 micrograms/kg/min. Hemodynamic evaluation indicated improvements in mean arterial pressure, cardiac output, and oxygen transport parameters during the period of hemodynamic support, which did not indicate a detrimental effect on perfusion of vital organs and tissues despite the use of this vasoconstrictor. Phenylephrine's pharmacologic properties may represent an advantage for its use as a vasoconstrictor over catecholamines such as norepinephrine and dopamine, particularly in patients who develop tachyarrhythmias with these agents. The pharmacology, dosage, and appropriate monitoring of therapy with phenylephrine in patients with septic shock are discussed.
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Affiliation(s)
- M F Bonfiglio
- College of Pharmacy, Ohio State University, Columbus
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Ferrari P, Ferrier CP, Franscini L, Saxenhofer H, Shaw S, Weidmann P. Atrial natriuretic factor and autonomic nervous system function in man. Eur J Clin Pharmacol 1990; 38:25-30. [PMID: 2139413 DOI: 10.1007/bf00314798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To delineate a possible interaction of atrial natriuretic peptide ANF-(99-126) with autonomic nervous system function in humans, a spectrum of indices were assessed in 10 healthy young men during a 90 min iv administration of a) synthetic ANF-(99-126) 50 micrograms bolus followed by 0.025 micrograms.kg-1.min-1, b) the potent vasodilator sodium nitroprusside (SNP) 0.35 micrograms.kg-1. min-1, or c) vehicle 0.9% NaCl40 ml and 20% albumin 5 ml, in random sequence. Plasma immunoreactive ANF (irANF) rose from 32 to 1700 pg.ml-1 during the ANF-(99-126) infusion and was stable during SNP or vehicle. Infusion of ANF-(99-126) and SNP, but not vehicle, decreased diastolic blood pressure (BP) on average by -9 and -7.5%, respectively; systolic BP was largely unchanged. Heart rate (HR, + 15 and 12%) or plasma norepinephrine (NE) rose similarly during ANF-(99-126) and SNP infusions, and the systolic BP response to orthostasis was similar (-18 mmHg). The following autonomic indices did not differ significantly after the 3 infusions: responses of HR and NE to orthrostasis; reflex bradycardic response to phenylephrine (PE)-induced rise in systolic BP (+ 20 mmHg); responses of BP to hyperventilation, PE, or 3 min of sustained handgrip; and beat-to-beat variation (R-R interval) during deep breathing. The immediate orthostatic HR response (30/15 R-R interval ratio) fell similarly during infusion of ANF-(99-126) or nitroprusside. The findings indicate that in healthy men the function of the autonomic nervous system is not notably impaired by high circulating ANF levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Ferrari
- Medizinische Poliklinik, University of Berne, Switzerland
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Shoukry AF, El-Sheikh R, Issa YM, Zareh M. Potentiometric sensor for phenylephrine based on phenylephrine-tetraphenylborate lipophilic salt. Mikrochim Acta 1989. [DOI: 10.1007/bf01242795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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