Transdermal monotherapy with mepindolol BIO TSD in patients with stable angina pectoris. Placebo-controlled, crossover investigation of a new therapeutic concept with 12-hours overnight application

10 patients (6 females and 4 males with an average age of 75 years) with stable angina pectoris were treated transdermally with mepindolol in a balanced, randomized, controlled, crossover study to compare the anti-ischemic effects of 12-hour overnight, and 24-hour applications. The number of angina pectoris attacks, the oral nitrate consumption and the ischemic parameters in 24-hour ECG, i.e. episodes of manifest (MMI) and silent (SMI) myocardial ischemia, the total duration of ischemia and 24-hour heart rate profiles were investigated. Both application schemes showed typical systemic beta blocker effects in all patients and significant clinical efficacy. A dose/effect relationship and a time/effect relationship between the two different application schemes were demonstrated across all the parameters investigated. Systemic and local tolerance of the therapy was good. 2 patients showed transient, mild skin irritation, but only during one phase of the study. Premature discontinuation was not necessary in any cases. There were no relevant changes in the clinical-chemistry. The new therapeutic concept of 24-hour treatment for a. pectoris with 12-hour overnight transdermal applications showed both good clinical efficacy and a good safety profile.

[Anti-ischemic action of the transdermally-applied beta-receptor blocker, mepindolol, in patients with stable angina pectoris. Comparison with transdermal nitrate]

A new transdermal beta-blocker containing system (Mepindolol BIO TSD) was compared in a placebo controlled cross over trial with a transdermal nitrate system in 14 patients suffering from coronary heart disease with stable angina pectoris. Under Mepindolol TSD both the incidence of angina pectoris attacks and the consumption of oral nitroglycerin dropped significantly. Under ergometry it resulted in an improvement in the maximum exercise tolerance and in a significant reduction in the ischemic ST-Segment deviation. Under Holter monitoring the number of manifest (MMI) and silent (SMI) ischemic episodes was significantly reduced. In addition the total duration of ischemia was significantly reduced. All the examined parameters showed Mepindolol BIO TSD to be significantly more effective than transdermal nitrate, and the duration of action was longer. No clinically relevant adverse events were observed in any of the therapeutic regimes.

[Anti-ischemic action of the transdermally applied beta-receptor blocker, mepindolol in patients with stable angina pectoris]

A new transdermal system (BIO TSD) containing the beta-adrenergic blocker mepindolol was assessed in a placebo controlled clinical trial in 12 patients with coronary heart disease. On therapy, the number of anginal attacks and the consumption of oral nitroglycerin (glyceryl trinitrate) were reduced significantly. During ergometer exercise the exercise tolerance was improved and the ischemic ST-segment depression was reduced significantly. Holter monitoring revealed significant reductions of the number of manifest and silent episodes and the total duration of ischemia. No relevant side effects were observed.

[Mechanisms of transcutaneous absorption. Pharmacologic and biochemical aspects]

Known and potential mechanisms of transcutaneous permeation or resorption of drugs are discussed. The relatively well documented transcellular route is passable for compounds with a low molecular mass (up to about 2000 Da) and sufficient lipid as well as water solubility. Because of the limited absorption capacity of the skin and the slow progress of absorption systemic effects of cutaneously applied drugs with the mentioned properties may be expected only, if they are acting in low concentrations and if a retarded onset of action is tolerable. Further compounds which do not fulfil these conditions sufficiently may be transported through the skin under the aid of exogenic factors such as permeation enhancers. Advantages, disadvantages and limitations of transdermal drug therapy as compared with other routes of application are discussed. Finally the question is dealt with, if the transcutaneous route can be opened also for polar compounds with a higher molecular mass. The permeation of such compounds could take place through intercellular clefts, which are reported to have dimensions permitting the passage of compounds with a molecular mass greater than 2000 Da. The transfer through the masses filling the clefts may require, however, the aid of sorption enhancers.

[Human pharmacologic studies on transdermal administration of mepindolol. Pharmacodynamic and orienting pharmacokinetics]

The pharmacodynamic effects of acute and repeated application of a transdermal patch (BIO TSD) containing 20 mg of the beta-receptor blocking agent mepindolol were assessed in 13 normotensive male volunteers. Orienting measurements of mepindolol serum levels were performed additionally. At rest, the effects on blood pressure and heart rate were very limited. However, during submaximum ergometer exercise, significant systemic beta-blocking effects were observed, especially after 5 days treatment. Repeated administration did not induce tachyphylaxis but resulted in an enhanced efficacy. The mepindolol serum concentrations were markedly lower than those measured after oral application of the drug. No systemic or local adverse reactions nor any relevant changes in laboratory parameters were observed.