Effect of sympathomimetic amines on the blocking action of guanethidine, bretylium and xylocholine

Pharmacokinetic and pharmacodynamic drug interactions in the treatment of attention-deficit hyperactivity disorder

The psychostimulants methylphenidate, amphetamine and pemoline are among the most common medications used today in child and adolescent psychiatry for the treatment of patients with attention-deficit hyperactivity disorder. Frequently, these medications are used in combination with other medications on a short or long term basis. The present review examines psychostimulant pharmacology, summarises reported drug-drug interactions and explores underlying pharmacokinetic and pharmacodynamic considerations for interactions. A computerised search was undertaken using Medline (1966 to 2000) and Current Contents to provide the literature base for reports of drug-drug interactions involving psychostimulants. These leads were further cross-referenced for completeness of the survey. Methylphenidate appears to be more often implicated in pharmacokinetic interactions suggestive of possible metabolic inhibition, although the mechanisms still remain unclear. Amphetamine was more often involved in apparent pharmacodynamic interactions and could potentially be influenced by medications affecting cytochrome P450 (CYP) 2D6. No published reports of drug interactions involving pemoline were found. The alpha2-adrenergic agonists clonidine and guanfacine have been implicated in several interactions. Perhaps best documented is their antagonism by tricyclic antidepressants and phenothiazines. In additional, concurrent beta-blocker use, or abrupt discontinuation, can lead to hypertensive response. Although there are few published well-controlled interaction studies with psychostimulants and alpha2-adrenergic agonists, it appears that these agents may be safely coadministered. The interactions of monoamine oxidase inhibitors with psychostimulants represent one of the few strict contraindications.

Adrenergic neurone blockade and other acute effects caused by N-benzyl-N'N"-dimethylguanidine and its ortho-chloro derivative

N-Benzyl-N'N"-dimethylguanidine sulphate (BW 467C60) and its ortho-chloro derivative (BW 392C60) had adrenergic neurone blocking and sympathomimetic effects resembling those of bretylium and guanethidine in cats, dogs and monkeys, but they were more potent in blocking adrenergic mechanisms in the cat. BW 467C60 was more active than its chloro derivative. Each compound inhibited release of noradrenaline during stimulation of the splenic nerve of cats, and increased smooth muscle responses to adrenaline and noradrenaline. Pressor responses to standard doses of tyramine were also increased except when large doses of BW 467C60 or BW 392C60 were given. The adrenergic neurone block by BW 467C60 was inhibited by dopamine, cocaine and amphetamine in situations in which these amines inhibit the effects of bretylium and guanethidine. In contrast to guanethidine, BW 467C60 and BW 392C60 did not lower the pressor amine content of the iris of cats 24 hr after administration of single doses of the compounds. BW 467C60 depressed the slope of curves relating the frequency of stimuli applied to the cervical sympathetic nerves and the resulting contraction of the nictitating membrane, but the effects of the lower rates of stimulation were preferentially inhibited. Large intravenous doses of BW 467C60 and BW 392C60 blocked autonomic cholinergic mechanisms and caused neuromuscular paralysis of voluntary muscle. These effects were brief, in contrast to the adrenergic neurone blockade. Both BW 467C60 and BW 392C60 were well absorbed from the alimentary tract. In contrast to guanethidine, BW 467C60 did not cause diarrhoea in guinea-pigs.

Evidence for a competitive antagonism of guanethidine by dexamphetamine

After guanethidine had blocked the response of the cat nictitating membrane to sympathetic nerve stimulation, dexamphetamine restored the responses to all frequencies of stimulation. Dexamphetamine antagonized the sympathetic nerve block by guanethidine in the isolated sympathetically innervated rabbit ileum; the evidence suggests that the antagonism was competitive. Dexamphetamine antagonized the sympathetic nerve block by guanethidine in the isolated hypogastric nerve-vas deferens preparation of the guinea-pig. Doses of dexamphetamine, larger than those required to antagonize the blocking action of guanethidine, abolished the responses of the nictitating membrane, ileum and vas deferens to nerve stimulation. Dexamphetamine did not influence the depletion of noradrenaline by guanethidine in the heart and spleen of rabbits. The hypothesis is advanced that both dexamphetamine and guanethidine act on the store of noradrenaline at sympathetic nerve endings.

SOME OBSERVATIONS ON THE PHARMACOLOGY OF ALPHA-METHYLDOPA

alpha-Methyldopa in high concentrations impaired the responses of rabbit isolated ileum and guinea-pig isolated vas deferens to stimulation of the sympathetic nerves and to noradrenaline, but these preparations taken from animals previously treated with alpha-methyldopa showed no sign of impairment. Contractions of the cat nictitating membrane were reduced but not abolished by alpha-methyldopa. In cats, dogs and rats, pressor responses to noradrenaline were usually slightly increased by alpha-methyldopa. Pressor responses to tyramine were not affected consistently. alpha-Methyldopa, alpha-methyldopamine and alpha-methylnoradrenaline behaved like dopa, dopamine and noradrenaline respectively in restoring the responses of tissues from reserpine-treated animals to stimulation of the sympathetic nerves to the rabbit ileum, the guinea-pig vas deferens and the cat nictitating membrane and in restoring responses to tyramine of the cat blood pressure and nictitating membrane, and the rat blood pressure. The potency of alpha-methylnoradrenaline relative to noradrenaline ranged from one-half to one-ninth on various preparations. The results are discussed in relation to the antihypertensive action of alpha-methyldopa.

THE EFFECTS OF GANGLION-BLOCKING AND POSTGANGLIONIC SYMPATHOLYTIC DRUGS ON PREPARATIONS OF THE GUINEA-PIG VAS DEFERENS

The contractions of the guinea-pig isolated vas deferens elicited by electrical stimulation of the hypogastric nerve were completely blocked by the following drugs: guanethidine, bretylium, dimethylphenylpiperazinium hydrochloride, nicotine, pempidine, hexamethonium, hemicholinium, D-tubocurarine and procaine. However, when the vas deferens was stimulated through an electrode in its lumen, the contractions in response to frequent, short stimuli (50 shocks/sec, 1 msec duration) were blocked by guanethidine, bretylium and dimethylphenylpiperazinium, but were not affected by the remaining drugs, except that procaine and hemicholinium each caused some reduction in the responses. When the preparation was stimulated transmurally with shocks of 200 msec duration at 1 shock/sec, the contractions were unaffected by any of the above drugs, except hemicholinium which again caused a slow reduction of up to 50% of the original response. It is concluded that nicotine, pempidine, hexamethonium, D-tubocurarine and hemicholinium probably block the response to stimulation of the hypogastric nerve by acting on peripheral ganglia in its pathway. Hemicholinium appears to have an additional effect in depressing the responses of the smooth muscle of the vas deferens to direct electrical stimulation, and procaine may act both on the ganglia and at the nerve terminals.

PREGANGLIONIC AND POSTGANGLIONIC STIMULATION OF THE GUINEA-PIG ISOLATED VAS DEFERENS PREPARATION

The isolated vas deferens of the guinea-pig contracted when stimulated transmurally with parallel wire electrodes. These contractions persisted in concentrations of hexamethonium, pentolinium, nicotine and mecamylamine which at the same time abolished the responses to hypogastric nerve stimulation. Procaine and lignocaine in local anaesthetic concentrations abolished the responses to transmural stimulation but potentiated the contractions produced by added noradrenaline. Guanethidine and bretylium in concentrations specific for adrenergic neurone blockade abolished the contractions due to transmural stimulation without impairing the responses of the muscle to added noradrenaline or acetylcholine. In contrast, high concentrations of the adrenergic-blocking agents phentolamine and dihydroergotamine were needed to block the contractions due to transmural stimulation; these concentrations also blocked the response to added noradrenaline but simultaneously reduced the responses to added acetylcholine or potassium chloride. Preparations from guinea-pigs previously treated with reserpine at first responded normally to transmural stimulation; thereafter the contractions diminished progressively but were never abolished. Hyoscine and atropine produced a small decrease in the response to transmural stimulation when present in concentrations up to 1x10(-5) and a larger decrease only in concentrations of 1x10(-4) or greater. Hemicholinium produced a small decrease of the contractions due to transmural stimulation in concentrations up to 1x10(-4); concentrations of 5x10(-4) present for 1 hr produced only a slightly greater reduction in response. These experiments show that when the guinea-pig vas deferens is removed without the hypogastric nerve and stimulated transmurally by the method described, contractions are produced mainly by excitation of postganglionic adrenergic nerves.

TACHYPHYLAXIS TO SOME SYMPATHOMIMETIC AMINES IN RELATION TO MONOAMINE OXIDASE

Tachyphylaxis to the effects of indirectly acting sympathomimetic amines has been studied on the blood pressure of the cat, rabbit and rat, on the cat spleen and nictitating membrane and on the rabbit heart. The pressor responses to tyramine and to phenethylamine declined slowly with repeated injection; the extent of tachyphylaxis induced by these amines depended on the dosage and on the frequency of injection. The pressor responses to alpha-methyltyramine and to dexamphetamine (alpha-methylphenethylamine) declined rapidly with successive injections. The tachyphylaxis induced by one indirectly acting sympathomimetic amine is crossed to others, but not to directly acting amines, such as noradrenaline. In animals treated with nialamide, a drug which inhibits monoamine oxidase, the tachyphylaxis induced by tyramine and by phenethylamine was similar to that produced by their alpha-methyl derivatives in normal animals. Similar results were obtained when the responses to indirectly acting sympathomimetic amines were studied on the cat spleen in situ and on the rabbit heart in vitro. Indirectly acting sympathomimetic amines impaired the responses of the cat nictitating membrane to sympathetic nerve stimulation; this effect was most evident with alpha-methylated amines.

A method for the differentiation of presynaptic inhibitors of adrenergic neurotransmitter release

Injection of clonidine hydrochloride, 30 microgram/kg iv, or bretylium tosylate, 5 mg/kg iv, in pithed male spontaneously hypertensive rats inhibits the pressor responses to stimulation of the total sympathetic outflow, and enhances those to injected noradrenaline. The intravenous injection of d-amphetamine sulphate, 200 microgram/kg, reverses bretylium inhibition of the responses to sympathetic stimulation but not that of clonidine. Yohimbine, 10 microgram/kg/min iv on the other hand, reverses clonidine inhibition of the responses to sympathetic stimulation, but not that of bretylium. This pharmacological analysis provides a method for the differentiation of the mechanism of effect of two types of antihypertensive drug which act presynaptically to impair the release of the neurotransmitter from sympathetic nerves, viz., sympathetic neurone blocking agents (such as bretylium tosylate) and presynaptic alpha-adrenoceptor stimulants (such as clonidine hydrochloride).

Comparison of the electrocortical changes induced by (+)-amphetamine and chlorpromazine when perfused directly into the dorsal raphé nucleus of the cat

1 (+)-Amphetamine mimicked the intermittent and sustained electrocortical desynchronization produced by (-)-noradrenaline (NA) when perfused directly into the dorsal raphé nucleus of cat encéphale isolé preparations. 2 The effects of amphetamine or NA were abolished or significantly attenuated by prior application of (-)-propranolol. 3 The effect of amphetamine, but not that of NA, was blocked by prior applications of guanethidine or chlorpromazine (CPZ). 4 Desmethylimipramine (DMI) produced dose-related changes in electrocortical activity which were similar to those induced by NA when applied to the same sites within the dorsal raphé nucleus. 5 DMI potentiated the effects of both amphetamine and NA, but guanethidine only abolished the DMI-induced potentiation of the amphetamine response. 6 (-)-Propranolol, guanethidine and CPA produced a short period of electrocortical desynchronization at the beginning of the perfusion period before antagonism of the amphetamine response was apparent. 7 The results suggest that CPZ and amphetamine have an action within the dorsal raphé nucleus possibly related to noradrenergic terminals.

Extra-vesicular binding of noradrenaline and guanethidine in the adrenergic neurones of the rat heart: a proposed site of action of adrenergic neurone blocking agents

1 The binding and efflux characteristics of [14C]-guanethidine and [3H]-noradrenaline were studied in heart slices from rats which were pretreated with reserpine and nialamide. 2 Binding of both compounds occurred at extra-vesicular sites within the adrenergic neurone. After a brief period of rapid washout, the efflux of [14C]-guanethidine and [3H]-noradrenaline proceeded at a steady rate. The efflux of both compounds appeared to occur from a single intraneuronal compartment. 3 (+)-Amphetamine accelerated the efflux of [14C]-noradrenaline; this effect was inhibited by desipramine. 4 Unlabelled guanethidine and amantadine also increased the efflux of labelled compounds. Cocaine in high concentrations increased slightly the efflux of [14C]-guanethidine but not that of [3H]-noradrenaline. 5 Heart slices labelled with [3H]-noradrenaline became refractory to successive exposures to releasing agents although an appreciable amount of labelled compound was still present in in these slices. 6 It is suggested that [14C]-guanethidine and [3H]-noradrenaline are bound at a common extravesicular site within the adrenergic neurone. Binding of guanethidine to the extra-vesicular site may be relevant to its pharmacological action, i.e., the blockade of adrenergic transmission.

On the mechanism of the accumulation of 3H-bretylium in peripheral sympathetic nerves

The uptake of bretylium-(N-3H-methyl) iodide in the rat heart atrium in vitro was examined. The uptake was linear for at least 1 hr and was strongly inhibited by (+)-amphetamine, (-)-noradrenaline, desipramine, cocaine, DSP 4 [N-(2-bromobenzyl)-N-(2-chloroethyl)ethylamine hydrochloride], guanethidine and ouabain. The amphetamine sensitive part of the uptake was almost completely abolished by pre-treatment of the rats with 6-hydroxydopamine and was dependent on the presence of sodium ions. Reserpine had no effect. (+)-Amphetamine but not desipramine caused an increase of the efflux of bretylium from the tissue. The apparent Km value of the active bretylium uptake was 3 x 10(-6) M, which was 10 times higher than that of the uptake of (-)-noradrenaline in the rat heart atrium (Km = 3 x 10(-7) M). The inhibition constants (Ki) for bretylium in inhibiting the noradrenaline uptake and for (-)-noradrenaline in inhibiting the bretylium uptake were 7 x 10(-6) M and 4 x 10(-7) M, respectively. The results obtained support the hypothesis that bretylium is taken up by the same mechanism as that carrying noradrenaline into the nerve terminals but is not bound in the noradrenaline storage vesicles.

Some characteristics of the adrenergic neurone blocking action of dehydroemetine

The uptake of dehydroemetine by adrenergic neurones was studied indirectly by testing the ability of various procedures to prevent or reverse adrenergic neurone blockade in the periarterially stimulated rabbit isolated ileum. Adrenergic neurone blockade was prevented but not reversed by equilibration with dehydroemetine at low temperature (0 degrees C), in the absence of sodium or in the presence of tetrodotoxin. Noradrenaline, cocaine, potassium deprivation and potassium excess did not modify the adrenergic neurone blocking action of dehydroemetine.

Factors influencing the adrenergic neurone blocking action of propranolol

1. The reversal by propranolol of its own adrenergic neurone blocking effect in the cat can be prevented by cutting the splanchnic nerves or by ligating the adrenal veins.2. In the absence of secretion from the adrenal medulla the nerve blocking action of propranolol is more complete, but can still be reversed by repeated injections or a constant infusion of adrenaline.3. Prior treatment with adrenaline or noradrenaline also prevents the development of the blocking action of propranolol in the cat and in the isolated guinea-pig vas deferens.4. It is suggested that in the cat, propranolol stimulates the release of catecholamines from the adrenal medulla which antagonize its nerve blocking effect.

Pharmacodynamic effects of dehydroemetine

The pharmacodynamics of dehydroemetine were studied in isolated preparations and in whole animals. Dehydroemetine had no effect on the guinea-pig isolated ileum but non-specifically antagonized the spasmogenic effect of histamine, acetylcholine and nicotine on this tissue. Dehydroemetine in small concentrations inhibited relaxations of the guinea-pig and rabbit ileum produced by stimulating the sympathetic nerve without inhibiting the effect of noradrenaline. Twitches of the guinea-pig ileum elicited by transmural stimulation were blocked by dehydroemetine while higher doses of the drug also inhibited the indirectly elicited contractions of the isolated rat diaphragm. In vivo, neuromuscular blocking action could not be demonstrated for dehydroemetine while toxic doses were required to demonstrate the presence of an adrenergic neuron blocking action. Dehydroemetine had no anaesthetic action when applied locally to the rabbit cornea. Concentrations of the drug which caused local anaesthesia when injected intradermally into guinea-pigs also caused skin necrosis. It is concluded that dehydroemetine lacks any specific adrenergic neuron blocking action or neuromuscular blocking action or local anaesthetic action. It is suggested that the effects demonstrated are due to non-specific action at the nerve endings.

Modification by choline of adrenergic transmission in rat mesenteric arteries

1. The action of choline on the vasoconstrictor responses of the perfused mesenteric arteries of the rat to sympathetic nerve stimulation and to injected noradrenaline has been investigated.2. The infusion of choline (500 mug/ml), for periods of 15 s, increased the response to sympathetic nerve stimulation, whereas the infusion of the same concentration for 20 min greatly reduced the response to nerve stimulation. Choline (up to 500 mug/ml), infused either for short or long periods, did not alter the response to injected noradrenaline.3. The inhibitory action of choline on the response to nerve stimulation was abolished either by an increase in the calcium concentration from 1.8 to 5.4 mM or by simultaneous infusion of (+)-amphetamine or atropine.4. The results suggest that choline in concentrations of 500 mug/ml has the same effect on adrenergic transmission in mesenteric arteries as acetylcholine at concentrations of 5 ng/ml.

Effect of amphetamine on the uptake, release and effectiveness of xylocholine in the guinea-pig vas deferens

Amphetamine sulphate will both reverse and prevent the adrenergic neuron blocking action of xylocholine (TM10 bromide) on the response of the guinea-pig isolated vas deferens to transmural electrical stimulation. A concentration of amphetamine sulphate capable of reversing the effect of xylocholine does not produce a significant reduction in the tissue concentration of 14C-TM10 iodide in the vas deferens. Although amphetamine reduces the rate of uptake of xylocholine, it does not prevent uptake. Comparisons of tissue concentrations with the degree of blockade produced in the normal and the amphetamine-treated vas deferens suggest that if the actions of amphetamine are to be accounted for entirely by displacement of xylocholine or by changes in uptake of xylocholine, only a very small percentage of the total tissue content of xylocholine can be involved in the production of its effects.

Factors affecting the action of guanethidine on adrenergic neurones

1. The uptake of guanethidine by adrenergic neurones has been studied indirectly by testing the ability of various procedures to prevent or reverse adrenergic neurone blockade in the periarterially stimulated isolated ileum preparation.2. Adrenergic neurone blockade was prevented but not reversed by equilibration with guanethidine (3.3 x 10(-6)M) at low temperatures (10 degrees C), in the absence of sodium or in the presence of tetrodotoxin (0.3 x 10(-6)M) or noradrenaline (1.2 x 10(-3)M).3. Calcium (5 x 10(-2)M) both prevented and, to some extent, reversed the adrenergic neurone blocking action of guanethidine.4. Equilibration with guanethidine in the presence of mersalyl (0.6 x 10(-7)M) or in the absence of potassium or calcium could neither prevent nor reverse adrenergic neurone blockade.

Adrenergic neuron blocking properties of (plus or minus)-propranolol and (plus)-propranolol

The action of (±)-propranolol and (+)-propranolol on the electrical stimulation of adrenergic nerves to smooth muscle has been studied in the isolated ear artery from rabbits and the isolated vas deferens preparation from rats. Both drugs exhibited an adrenergic neuron blocking action at a pre-junctional site at concentrations ranging from 4·6 to 14 μg/ml. At lower concentrations the effects were variable and more often potentiation of the responses was observed. The responses to added noradrenaline were uniformly potentiated. The effect was related to local anaesthetic activity and not considered to be a specific adrenergic neuron blocking effect as occurs with guanethidine or bretylium.

Prejunctional actions of some beta-adrenoreceptor antagonists in the vas deferens preparation of the guinea-pig

1. The beta-adrenoceptor antagonists propranolol, pronethalol, MJ 1999 and Ciba 39089-Ba reduced responses to field stimulation of the guinea-pig isolated vas deferens preparation without significantly affecting responses to exogenously added noradrenaline.2. This prejunctional blocking action of the drugs cannot be correlated with their action as beta-adrenoceptor antagonists or non-specific depressants.3. The blockade produced was more pronounced at low (5-20 Hz) than at high (50 Hz) frequencies of stimulation.4. The blockade was slow in onset, and once established was poorly reversed by washing the preparation over a period of 1 to 2 h.5. The blockade produced could be reversed by dexamphetamine and cocaine.6. These experiments suggest that the beta-adrenoceptor antagonists may have some actions which closely resemble those of the adrenergic neurone blocking agent guanethidine.

The antagonism of adrenergic neurone blockade by amphetamine and dexamphetamine in the rat and guinea-pig

1. In isolated rat mesentery preparations, intra-arterial injection of the following drugs rapidly suppressed vasoconstrictor responses to sympathetic nerve stimulation: bretylium (75-100 mug), guanethidine (10-20 mug) and bethanidine (20-30 mug); with phenoxypropylguanidine (15-30 mug) the onset of blockade was slower. The blockade caused by these or higher concentrations was rapidly abolished by intra-arterial injection of amphetamine (100 mug) as also was the blockade caused by infusing bretylium or guanethidine for 10-20 min. Partial blockade was produced by 20 mug of reserpine and this was only slightly and briefly antagonized by amphetamine.2. In mesentery preparations taken from rats 24 h after subcutaneous injection of bretylium 50 mg/kg, guanethidine 10 mg/kg, phenoxypropylguanidine 10 mg/kg or reserpine 0.1 mg/kg, responses to sympathetic nerve stimulation were greatly impaired. Only in the preparations from the bretylium-treated rats did amphetamine antagonize the blockade. The adrenergic neurone blocking effect of bethanidine 10 mg/kg was evident at 12 h but not at 24 h after injection.3. In rat mesentery amphetamine did not cause vasoconstriction but briefly potentiated the vasoconstrictor effect of sympathetic nerve stimulation. Responses to noradrenaline were not importantly affected.4. The contractile responses of the rat inferior eyelid caused by stimulation of the cervical sympathetic nerve was greatly reduced 17-27 h after subcutaneous injection of bretylium 300 mg/kg, bethanidine 30 mg/kg, guanethidine 10 mg/kg or reserpine 0.3 mg/kg. Intravenous dexamphetamine (0.5 mg/kg) powerfully antagonized the effect of bretylium, weakly antagonized the blockade by bethanidine and guanethidine and caused no change in the response of reserpine-treated animals.5. The vas deferens taken from guinea-pigs 24 h after subcutaneous injection of either bretylium or guanethidine showed greatly impaired responses to hypogastric nerve stimulation. Amphetamine largely restored the contractile response in bretylium-treated rats but caused only weak antagonism in the guanethidine-treated animals.

Selective depletion of noradrenaline: a proposed mechanism of the adrenergic neurone-blocking action of bretylium

1. The effects of bretylium have been investigated on the content and sub-cellular distribution of noradrenaline in cat spleen and on the overflow of noradrenaline in response to stimulation of the splenic nerve.2. Bretylium, 15 min after its administration, produces a significant depletion of noradrenaline in only the supernatant fraction of an homogenate; at this time adrenergic neurone blockade is evident. This depletion of noradrenaline is apparent up to 18 h later but has disappeared 7 days after the administration of bretylium when nerve function is also restored.3. Both the development of the neurone blockade and the depletion of noradrenaline are prevented by previous administration of (+)-amphetamine.4. In bretylium-pretreated cats the noradrenaline content of the supernatant fraction is replenished and the neurone blockade is abolished after treatment with (+)-amphetamine.5. The depletion of noradrenaline, which is evident 30 min, 60 min and 18 h after treatment with bretylium, from other subcellular fractions-especially the high-speed particulate fraction-appears to be unassociated with adrenergic neurone blockade.6. It is concluded that bretylium produces its adrenergic neurone-blocking activity by depleting noradrenaline from a "store" whose amine appears in the supernatant fraction after homogenization. Whilst bretylium is present this "store" cannot refill with noradrenaline.

The effect of 1,1-dimethyl-4-phenyl-piperazinium on the response of mesenteric arteries to sympathetic nerve stimulation

The effect of 1,1-dimethyl-4-phenylpiperazinium (dmpp) on the response to sympathetic nerve stimulation of rat mesenteric arteries perfused with Tyrode solution at a constant flow has been studied. dmpp (0·3 μg/ml) infused for 3 min enhanced the vasoconstriction caused by stimulation. Infusion of the same concentration for 16–40 min greatly reduced the response to nerve stimulation but did not affect the vasoconstrictor response to injected noradrenaline. The blockade of the response to nerve stimulation produced by dmpp was overcome either by adding (+)-amphetamine to the perfusion fluid or by raising the calcium concentration. Neither effect of dmpp was altered by the infusion of atropine. These effects of dmpp were similar to those seen when acetylcholine was added to the perfusion fluid except that the effects of acetylcholine were diminished or abolished by a concentration of atropine much higher than that of acetylcholine. It is concluded that the receptors at the adrenergic nerve terminals are partly muscarinic and partly nicotinic.

Mechanism of the antagonism between guanethidine and dexamphetamine

1. The effects of dexamphetamine were studied on the responses of rabbit ileum, rabbit ear artery and sheep spleen to sympathetic nerve stimulation after exposure to guanethidine and in the absence of guanethidine.2. In the absence of guanethidine, dexamphetamine enhanced the responses to sympathetic stimulation and, in the spleen, this was shown to be due to an increase in noradrenaline output. However, the increase in these responses was much less than the increase obtained in preparations treated with guanethidine.3. Cocaine, in a concentration which produced the same effect on noradrenaline uptake as the concentration of dexamphetamine used, was also effective in reversing the adrenergic neurone blocking actions of guanethidine.4. It is suggested that the antagonism between dexamphetamine and guanethidine is due to a reduction in the uptake of guanethidine by the nerve endings rather than to interaction of the two drugs at the receptor site for the adrenergic neurone blocking action of guanethidine.

An adrenergic neuron blocking action of propranolol in isolated tissues

Propranolol was tested for adrenergic neuron blocking activity in three isolated sympathetically-innervated smooth muscle preparations; the rat vas deferens, rabbit ileum and rabbit ear artery. In each preparation propranolol impaired the responses to sympathetic stimulation without reducing the responses to added noradrenaline. This blocking action of propranolol resembled that of guanethidine in time of onset and persistence of blocking activity but, unlike blocking by guanethidine, was not reversed by (+)-amphetamine. Desipramine and noradrenaline also failed to reverse the blocking action of propranolol. In the rat vas deferens preparation lignocaine had a weaker and more transient sympathetic blocking action than propranolol. It is suggested that the sympathetic blocking action of propranolol may contribute to its antihypertensive effect in man.

Subcellular distribution of [3H]amphetamine and [3H]guanethidine and their interaction with adrenergic neurons

The subcellular distribution of [3H]amphetamine and [3H]guanethidine and their interaction with each other and with noradrenaline binding sites have been examined. The ratio p/(p + s) × 100, an indication of affinity for noradrenaline storage particles, for [3H]amphetamine and [3H]guanethidine was 12% and 57% respectively. Protriptyline, a substance which inhibits amine transport mechanism at the level of the cell membrane, i.e. the membrane pump, and reserpine, an agent which impairs incorporation of amines into the storage particles in the adrenergic nerve fibre, inhibited the uptake and storage respectively, of [3H]guanethidine more than that of [3H]amphetamine. Retention of [3H]guanethidine by rat salivary glands was markedly decreased by sympathetic denervation of the glands while that of [3H]amphetamine was not. The results suggest that guanethidine possesses a much higher affinity for noradrenaline binding sites than amphetamine.

Studies on the distribution and excretion of a metabolite of guanethidine in the rat

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A comparison of aralkylamines and aralkylguanidines as antagonists of adrenergic neurone blockade

Structure-activity relationships have been studied for aralkylamines and aralkylguanidines which restore the responses of the nictitating membranes to nerve stimulation in anaesthetised cats given sympathetic blocking drugs. This reversing action was largely specific for adrenergic neurone blockade; blockade of sympathetic ganglia or of α-adrenergic receptors was unaffected. (+)-Amphetamine was the most active amine and N-benzyl-N-methylguanidine was the most active guanidine. In mice, ptosis resulting from adrenergic neurone blockade was much more readily prevented or abolished by the aralkylamines and aralkylguanidines than was ptosis caused by other types of sympathetic blocking agent. The most potent antagonist of ptosis was N-(2-phenylcyclopropyl)guanidine which was about ten times as active as amphetamine. The relative antagonistic potencies of 2 amines and 8 guanidines were virtually identical for all types of adrenergic neurone blocking drug, regardless of whether or not they cause noradrenaline depletion. The prevention of guanethidine-induced ptosis was always accompanied by some reduction in the extent of heart-noradrenaline depletion, but the minimum dose of antagonist required to prevent ptosis completely was always lower than that required to eliminate depletion.

The inhibitory nerve fibres in the vagal supply to the guinea-pig stomach

1. A comparison was made between the inhibitory responses of the isolated atropinized guinea-pig stomach to stimulation of the vagus and to stimulation of the perivascular nerves.2. When low frequencies of stimulation were used, the vagi were more effective than the perivascular nerves in causing relaxation of the stomach.3. The responses to vagal stimulation were faster in onset than were the responses to perivascular nerve stimulation.4. Responses to perivascular nerve stimulation were abolished by low concentrations of bretylium, whereas responses to vagal stimulation were only slight reduced. Vagal responses were strongly reduced by higher concentrations of bretylium.5. Amphetamine relieved the blockade of perivascular nerve responses which was caused by bretylium, but never relieved the reduction of the vagal responses.6. It is argued that the vagal inhibitory fibres are not susceptible to ;adrenergic neurone blockade', the observed reduction of the responses being due to some other action of bretylium.7. These differences between the vagal and perivascular inhibitory innervations of the stomach suggest that the post-ganglionic fibres in the vagal pathway and the intramural inhibitory nerves described in the guinea-pig caecum are similar.