Cardiac effects of the new H2-receptor antagonists

Effect of inhaled leukotriene D4 on airway eosinophilia and airway hyperresponsiveness in asthmatic subjects

Inhaled cysteinyl leukotrienes may cause recruitment of eosinophils into asthmatic airways. We compared the effects of inhaled leukotriene D4 (LTD4), methacholine, and allergen on airway eosinophils in 10 nonsmoking, atopic, mildly asthmatic subjects in a double-blind, diluent-controlled, randomized crossover study. Concentrations of LTD4, methacholine, and allergen resulting in a 30% decrease in FEV1, and diluent controls (ethanol and saline), were inhaled with at least 7 d between challenges. Spirometry was conducted for 4 h after inhalation challenge, and airway hyperresponsiveness (AHR) to methacholine was measured before and 24 h after challenge. Sputum was induced before and 4 h, 7 h, and 24 h after challenge. The maximum decrease in FEV1 was 31.4 +/- 1.8% with LTD4, 39.4 +/- 2.8% with methacholine, and 30.1 +/- 3.4% with allergen. AHR to methacholine, at the provocative concentration causing a 20% decrease in FEV1 (PC20), was enhanced 24 h after allergen challenge, but remained unchanged 24 h after LTD4 and methacholine (p > 0.05). The percentage of eosinophils in sputum was increased after inhalation of allergen at 7 h and 24 h (p = 0.003), but not after LTD4 or methacholine (p = 0.70). We demonstrated that neither inhalation of LTD4 nor of methacholine at concentrations causing submaximal bronchoconstriction increases the number of sputum eosinophils in the airways of mildly asthmatic subjects. However, LTD4 may still be an important cofactor for eosinophil recruitment in asthma.

Effects of histamine on atrial and ventricular contractility in the canine isovolumic heart

The effects of intracoronary administration of histamine on atrial and ventricular contractility were determined in a paced canine isovolumic heart preparation. Contractility was assessed by recording the pressure developed in saline-filled balloons placed in each of the four cardiac chambers. At doses above 0.1 mg and up to 100 mg histamine produced dose-related positive inotropic responses in all chambers. These were preceded by transient negative effects. The positive responses were not affected by a combination of H1 and H2 receptor antagonists antazoline and cimetidine but were almost completely abolished by the beta adrenoceptor blocker timolol. The negative responses were uninfluenced by either treatment. It was concluded that, in the canine isovolumic heart not subjected to complicating chronotropic and extracardiac factors, moderate doses of histamine are devoid of inotropic effects. Higher doses do produce myocardial stimulation, not mediated by histamine receptors, but probably due to norepinephrine release. These responses are preceded by transient non-specific depressant effects.

Action of the new H2-receptor antagonist oxmetidine on the duodenum of different species

The new H2-receptor antagonist, oxmetidine was studied for its effects on the motility of the duodenum of different species. Oxmetidine did not modify basal motility of the rat and guinea pig duodenum but it reduced or abolished the contractions elicited by different spasmogenic compounds (acetylcholine, BaCl2, KCl, eledoisin). In the rabbit duodenum, oxmetidine reduced in a dose-dependent fashion the basal motility. The effect of this compound appears to be indirect on the smooth muscle and not mediated through specific receptors. Experiments performed in Ca++-free and K+-depolarizing solution suggest that oxmetidine acts through interference with the transport and/or utilization of intracellular Ca++ions.

Relaxant effect of the H2-receptor antagonist oxmetidine on guinea-pig and human airways

The effects of three different H2-receptor antagonists (cimetidine, ranitidine and oxmetidine) were tested on isolated preparations of guinea-pig trachea and human bronchus against contractions induced by acetylcholine, histamine and potassium chloride (KCl). In addition, their influence on calcium concentration-response curves in guinea-pig tracheal spirals was examined in a potassium-rich solution (30 mM). Finally, their effects were studied in vivo against acetylcholine and histamine-induced bronchoconstriction in anaesthetized guinea-pigs. In guinea-pig isolated trachea, oxmetidine--in contrast to cimetidine and ranitidine, which were completely inactive--induced a concentration-dependent relaxation regardless of the excitatory stimulus: its--log EC50 values (i.e. the negative log concentration that caused a 50% relaxation) were 3.46 +/- 0.11, 4.61 +/- 0.09 and 4.20 +/- 0.12 against acetylcholine, histamine and KCl, respectively. In Ca2+-free, K+-enriched solution, the compound was able to inhibit Ca2+-induced contractions at concentrations close to those needed to counteract the spasmogenic effect of histamine in normal Krebs solution. Results obtained in the human bronchus preparation were similar to those observed in guinea-pig tracheal spirals. When tested against acetylcholine or histamine-induced bronchoconstriction in vivo, oxmetidine (10 and 30 mg Kg-1 intravenously) significantly reduced the increase in pulmonary airway resistance (Raw) induced by both agents. Once again, cimetidine and ranitidine were completely ineffective. In summary, oxmetidine displayed non-specific antispasmogenic activity on guinea-pig and human airways. This effect, which is independent of H2-receptor blockade, represents a side-effect of the drug which may be connected to its interference with Ca2+ influx and the action or release of intracellular Ca2+.

Adverse reactions and interactions with H2-receptor antagonists

Histamine H2-receptor antagonists have been used in the treatment of gastrointestinal diseases for more than a decade and during this period have become one of the most commonly prescribed groups of drugs in the world. The deserved popularity of the H2-receptor antagonists reflects, in part, their therapeutic efficacy, which has revolutionised the treatment of peptic ulcer disease. An equally, or more, important reason for the widespread use of H2-receptor antagonists is their remarkably low toxicity. We have attempted, in this review, to present a detailed account of the minor and more serious adverse reactions, while emphasising the low incidence of the former and the rarity of the latter. The toxicology of the H2-receptor antagonists is discussed under two main headings: adverse effects; and drug interactions. The latter category is potentially the more significant, since the frequent use of therapy with multiple drugs may give rise to drug interactions, some of which are serious and may even be lethal. These drug interactions occur especially in the gastrointestinal tract, the liver and the kidneys. Thus, the absorption of other drugs may be altered because the H2-receptor antagonists inhibit gastric secretion--an effect illustrated by ketoconazole, the absorption of which is reduced when given in combination with cimetidine. Very important drug interactions are caused by inhibition of the hepatic microsomal enzyme cytochrome P450 by some of the H2-receptor antagonists. This effect appears to be related to the chemical structure of the individual H2-receptor antagonists and is not attributable to histamine H2-receptor blockade. For example, cimetidine is a powerful inhibitor of cytochrome P450, while the interaction of ranitidine with this system is weaker. Consequently, cimetidine reduces the metabolism of many drugs which are normally degraded by phase I reactions, leading to potentially toxic plasma concentrations of therapeutic agents such as some oral anticoagulants, beta-blockers, anticonvulsants, benzodiazepines and xanthines. Some of the H2-receptor antagonists are actively secreted by the renal tubules and may thus compete with other drugs for cationic tubular transport mechanisms, resulting in reduced urinary excretion and hence potentially toxic plasma concentrations. This type of drug interaction has been reported after administration of both cimetidine and ranitidine with procainamide or quinidine.(ABSTRACT TRUNCATED AT 400 WORDS)

Protein binding properties of some histamine H2 antagonists: a 1H nuclear magnetic resonance study of antihistamine-calmodulin interactions

Oxmetidine (SK & F 92994) is a potent histamine H2 antagonist, which, however, also demonstrates cardiac effects consistent with its inhibiting transmembrane calcium fluxes. 1H nuclear magnetic resonance has been used to show that oxmetidine binds to a single site on the regulatory calcium-binding protein, calmodulin. Binding requires the presence of at least two equivalents of calcium per mol protein, is characterized by fast exchange behaviour and a dissociation constant of about 4 mM and is not affected by the presence of trifluoperazine. Protein-induced spectral changes and a limited study of structure-affinity relationships suggest the importance of the drug imidazole and benzyldioxymethylene groups in determining the strength of the interaction. Drug-induced perturbations in the spectrum of calmodulin indicate that the binding site is in the C-terminal half of the protein, and involves a hydrophobic area containing His-107, Met-144, Met-145 and possibly Phe-89, Phe-141, and calcium binding site III.

Evidence that oxmetidine inhibits transmembrane-calcium flux in cardiac and vascular tissue

Oxmetidine, at concentrations in excess of 1 X 10(-6)M, caused concentration-dependent negative inotropic and chronotropic responses in guinea-pig isolated heart preparations. Oxmetidine, at concentrations in excess of 1 X 10(-5)M, caused negative inotropic responses in guinea-pig papillary muscle preparations. The negative inotropic responses to oxmetidine were associated with shortening of the plateau phase of the action potential. Verapamil and nifedipine caused similar shortening of the plateau phase of the action potential at equivalent negative inotropic concentrations indicating that oxmetidine may also act as a calcium antagonist. In preparations partially depolarized by raising extracellular K+ concentration, oxmetidine also exhibited negative inotropic activity and reduced the calcium-dependent action potential. However, unlike verapamil and nifedipine, oxmetidine did not show voltage-dependent activity. Oxmetidine, at concentrations in excess of 1 X 10(-5)M, inhibited Ca2+-dependent contractions of dog saphenous vein preparations and inhibited 45Ca2+-uptake into veins depolarized by high extracellular K+. In vivo, these calcium antagonist actions of oxmetidine were demonstrated by vasodilatation, reduction in blood pressure, bradycardia and reduced cardiac output in anaesthetized cats. Oxmetidine, at concentrations of 1 X 10(-5)M and above, shows properties consistent with inhibition of transmembrane Ca2+ flux. This action can be distinguished from other calcium antagonists as the effects of oxmetidine are not voltage-dependent.

Histamine H2 receptor antagonists may modify dog intestinal motility independently of their primary action on the H2 receptors

Various histamine H2 receptor antagonists were tested for their possible effects on intestinal motility of the dog both "in vivo" and "in vitro". They were found to behave quite differently from one another: ranitidine exerted a small atropine-sensitive stimulatory effect by itself and strongly potentiated the stimulatory action of compounds which interfere with the cholinergic system thus confirming its cholinomimetic direct and/or indirect activities. Cimetidine and mifentidine were ineffective even at very high doses. Oxmetidine exerted an inhibitory effect independently of the kind of the stimulant agent and this suggested a direct effect on the smooth muscle. The different effects elicited by the above H2 antagonists indicate that their action on the intestinal motility is completely independent of the H2 blockade. This was furtherly confirmed by the lack of effect shown by the H2 receptor selective agonists, dimaprit and impromidine. The motor effects of ranitidine were, so far, the only ones which have been encountered, in different conditions, also in humans.

Action of the new H2-antagonist, DA 4577, on different in vitro and in vivo preparations

The new H2-antagonist, 4(5)-(4- isopropylaminomethyleniminophenyl )-imidazole (compound marked DA 4577), was tested for its activity on different in vitro preparations and also in the conscious cat. Its effect was compared with that of some new H2 antagonists. Two sets of experiments were performed: in the first, concerning the specific H2-receptor antagonism, DA 4577 was found to be extremely potent on the guinea-pig papillary muscle and on the human atrium stimulated by histamine (pA2 = 8.24 and 8.60 respectively). Compound DA 4577 was also found very active in inhibiting histamine-induced acid secretion from the isolated rat fundus (pA2 = 7.37) and on the dimaprit-induced gastric secretion in conscious gastric fistula cats (ID50 = 0.39 mumol kg-1 h-1). In the second set of experiments, concerning effects independent of the H2-receptor blockade (side effects of the molecule), compound DA 4577 was found to be devoid of negative inotropic effect on the human atrium in the absence of histamine stimulation; in this respect it behaved like cimetidine or ranitidine but unlike oxmetidine which showed a constant negative inotropic effect even at concentration 10 times lower than those of DA 4577. Furthermore DA 4577 was ineffective in modifying gastrointestinal motility in vitro in concentrations up to 3 X 10(-4) M, conversely from ranitidine (which stimulated motility) and oxmetidine (which inhibited motility). On the whole DA 4577 appeared to be a very potent and selective H2 antagonist which, unlike other members of the family, is devoid of non-specific effect on human atrium and on motility of the gastrointestinal tract of different animal species.

Action of histamine and of some H2-antagonists on gastric secretion 'in vitro'

The effect of histamine and of some H2-antagonists on isolated gastric mucosal preparation from immature (14-18 days) rats, was investigated. Basal secretion varied, in our experimental conditions, between 1.06 and 3.54 mumol cm-2 h-1, reaching higher values (approximately 4.6 mumol cm-2 h-1) only in a small percentage of animals (10%). Histamine exerted a concentration-dependent stimulation of acid secretion in concentrations varying between 2 X 10(-6) and 1.6 X 10(-4) M. The response to histamine was competitively antagonized by ranitidine (pA2 value = 6.78) and by 4(5)-(4- isopropylaminomethyleniminophenyl ) imidazole (compound marked DA 4577) (pA2 value = 7.37). Oxmetidine acted as a competitive antagonist only for concentrations as low as 10(-8) M; higher concentrations (10(-7) and 10(-6) M) determined a non-competitive inhibition. Ranitidine and compound marked DA 4577 did not affect basal secretion up to concentrations of 3 X 10(-4) M. On the contrary oxmetidine exerted a concentration-dependent inhibition starting from 10(-5) M. Since in our experimental conditions the role of calcium ions in the regulation of basal secretion could not be established, the mechanism of action of oxmetidine was not completely clarified, even if an interference in the utilization of calcium ions may be suggested. In any case it is deemed of interest that this H2-antagonist was the only compound capable of inducing a reversible complete inhibition of basal acid secretion (only KSCN, in very high concentrations, had a similar behaviour).

Action of oxmetidine on the rabbit aorta: comparison with some calcium entry blockers and nitroglycerin

The novel histamine H2 receptor antagonist, oxmetidine, was tested on isolated rabbit aorta for its activity on calcium ion transport and/or utilization suggested from previous experiments. Its effect was compared with that of some "classical" calcium entry blockers (verapamil, D-600 and nifedipine) and of nitroglycerin which acts predominantly on the intracellular calcium. The effect of all these compounds was evaluated against the contraction elicited by KCl, angiotensin and noradrenaline acting by different spasmogenic mechanisms. Oxmetidine was found to antagonize to approximately the same extent the effect of the three stimulatory substances: however concentrations required for this effect were from 10 to 100 times as high as those required to inhibit histamine H2 receptors. Nitroglycerin behaved quite similarly but was approximately 10.000 times more potent than oxmetidine. Verapamil and D-600 (which were virtually identical) were always more potent (about 10 times) than oxmetidine but less efficacious on the angiotensin-induced contraction. Finally nifedipine was the most active compound on the KCl induced contraction but was almost ineffective against angiotensin. It is concluded that oxmetidine, though with a still unclear mechanism, possesses a weak but definite inhibitory effect on the availability of the intracellular calcium resembling the effect of nitroglycerin. Whether or not an action on the influx of calcium is also present cannot be surely established as long as calcium fluxes are not measured. Differences in the behaviour of the "classical" calcium entry blockers suggest that each of them possesses, together with the main well recognized effect, additional effects responsible for apparently surprising results obtained against different spasmogenic compounds.

Negative inotropic effect of some H2-receptor antagonists on the isolated human atria

H2-Receptor antagonists were found to possess in various degrees a negative inotropic effect on human atria in vitro. This effect seemed to be independent of H2-receptor blockade and, at least in the case of oxmetidine, seemed to involve calcium ion transport and/or utilization.

Effect of some new H2-receptor antagonists on gastrointestinal motility

Some new histamine H2-receptor antagonists were tested for their effects on gastrointestinal motility. Ranitidine was found to possess definite stimulatory effects which appeared to be connected with an interference with the cholinergic system and occurred, though in different degree, from the lower esophageal sphincter (LES) to the colon. Etintidine, on the contrary, showed a remarkable antimuscarinic effect on the LES of the rat and the guinea-pig. Cimetidine, SK&F 93479 and tiotidine were virtually ineffective whereas oxmetidine exerted a consistent inhibitory activity on both basal motility and on the contractions induced by a variety of stimulatory agents. This effect, which was completely independent of the autonomic nervous system appeared to be connected with an inhibition of the transport of calcium ions. All the above results suggest that the H2-antagonists so far available may not be absolutely selective for the H2-receptor but may be endowed with non-specific effects which could have an interest at least from a pharmacological viewpoint.