Total metadrenaline excretion in patients treated with alpha-methyldopa

REVERSAL OF THE EFFECT OF ALPHA-METHYLDOPA BY MONOAMINE OXIDASE INHIBITORS

L-α-Methyldopa, which normally causes sedation, induces a strong central excitation in mice pretreated with a monoamine oxidase inhibitor after a lag of a few hours. It is concluded that this excitation is caused by accumulation of free catecholamines liberated by amines which are slowly formed by decarboxylation of α-methyldopa. The hypotensive and sedative effects of α-methyldopa given alone are attributed to the slow release of catecholamines and subsequent breakdown by monoamine oxidase so that a partial depletion of catecholamines ensues.

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.

URINARY EXCRETION OF METABOLITES OF CATECHOLAMINES IN NORMAL INDIVIDUALS AND HYPERTENSIVE PATIENTS

The 24-hour urinary output of 3-methoxy-4-hydroxy mandelic acid (V.M.A.) has been determined in 20 normal adults, 150 hypertensive patients, and four cases of phaeochromocytoma. In this last group estimations of urinary catecholamines and total urinary methylated amines were also performed and the overall results have been compared with the urinary excretory pattern of catecholamines and their metabolites following the injection of radioactive adrenaline and noradrenaline.

HPLC for urinary catecholamines and metanephrines with alpha-methyldopa

In five healthy selected volunteers with normal blood pressure and one pheochromocytoma patient, high performance liquid chromatography (HPLC) has been evaluated, with electrochemical detection for quantitation of urinary catecholamines and metanephrines during administration of the antihypertensive, alpha-methyldopa. The clinical usefulness of HPLC is compared with that of the conventional assay method--the trihydroxyindole (THI)-fluorometric procedure. The THI fluorometric method is known to suffer from true false-positive interference as a result of its inability to differentiate between alpha-methyldopa, its primary metabolic derivatives, and the structurally similar endogenous catecholamines. It is shown that the HPLC separation methodology yields accurate, reproducible results devoid of interference from the presence of alpha-methyldopa. Free urinary excretion rates of epinephrine, norepinephrine, and dopamine were elevated by alpha-methyldopa, P less than 0.001, for epinephrine, norepinephrine, and dopamine when measured by the trihydroxyindole technique but not with high performance liquid chromatography. With alpha-methyldopa treatment, urinary normetanephrine excretion rates were slightly increased, P less than 0.05, by fluorometric analysis and slightly decreased. P less than 0.05, when measured by HPLC. Of added interest, the formation of the normetanephrine analog of alpha-methyldopa, previously undetected, is suggested. Slightly elevated metanephrine levels are seen by the THI-fluorometric method in the presence of alpha-methyl metanephrines. Establishing that the HPLC assay procedure is suitable for clinical diagnosis of pheochromocytoma, despite the presence of alpha-methyldopa, makes it unnecessary to discontinue use of this antihypertensive in screening for pheochromocytoma.

A simple chromatographic technique for the estimation of urinary levels of normetadrenaline and metadrenaline

A simple, but effective, procedure is described for the concurrent estimation of normetadrenaline (NMA) and metadrenaline (MA) in urine. The 3-methoxycatecholamines are adsorbed by a cation exchange resin, desorbed, separated by paper chromatography, and finally estimated spectrophotometrically after oxidation to vanillin. The mean (+/- 2 standards deviations) urinary outputs of NMA and MA from 123 normals (80 males, 43 females) in 24 hours was 2.15 +/- 1.04 and 1.79 +/- 0.96 mu mol respectively. There was no significant difference in the 24-hour urinary outputs of NMA between the male and female groups. However, the output of MA from the males was significantly higher than that from the females.

A hypothesis for the mode of action of alpha-methyldopa in relieving hypertension

There is evidence that α-methyldopa can serve as the precursor of α-methylnoradrenaline in the body. The α-methylnoradrenaline so formed may enter noradrenaline storage sites and then be released as a false neuro-transmitter. Because of the lesser potency of α-methylnoradrenaline there is some loss of responsiveness to sympathetic nerve stimulation which can explain the lowering of blood pressure in hypertensive patients.