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Maestrelli F, Cirri M, Mennini N, Fiani S, Stoppacciaro B, Mura P. Development of Oral Tablets of Nebivolol with Improved Dissolution Properties, Based on Its Combinations with Cyclodextrins. Pharmaceutics 2024; 16:633. [PMID: 38794295 PMCID: PMC11124990 DOI: 10.3390/pharmaceutics16050633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
New oral tablets of nebivolol have been developed aiming to improve, by cyclodextrin (CD) complexation, its low solubility/dissolution properties-the main reason behind its poor/variable oral bioavailability. Phase-solubility studies, performed using βCD and highly-soluble βCD-derivatives, indicated sulfobutylether-βCD (SBEβCD) as the best solubilizing/complexing agent. Solid drug-SBEβCD systems were prepared by different methods and characterized for solid-state and dissolution properties. The coevaporated product was chosen for tablet development since it provided the highest dissolution rate (100% increase in dissolved drug at 10 min) and almost complete drug amorphization/complexation. The developed tablets reached the goal, allowing us to achieve 100% dissolved drug at 60 min, compared to 66% and 64% obtained, respectively, with a reference tablet without CD and a commercial tablet. However, the percentage dissolved after 10 min from such tablets was only 10% higher than the reference. This was ascribed to the potential binding/compacting abilities of SBEβCD, reflected in the greater hardness and longer disintegration times of the new tablets than the reference (7.64 vs. 1.06 min). A capsule formulation with the same composition of nebivolol-SBEβCD tablets showed about a 90% increase in dissolved drug after 5 min compared to the reference tablet, and reached 100% dissolved drug after only 20 min.
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Affiliation(s)
| | - Marzia Cirri
- Department of Chemistry, School of Human Health Sciences, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy; (F.M.); (N.M.); (S.F.)
| | | | | | | | - Paola Mura
- Department of Chemistry, School of Human Health Sciences, University of Florence, Via Ugo Schiff 6, 50019 Florence, Italy; (F.M.); (N.M.); (S.F.)
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2
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Hanif N, Zamir A, Imran I, Saeed H, Majeed A, Rehman AU, Ashraf W, Alqahtani F, Rasool MF. Clinical pharmacokinetics of nebivolol: a systematic review. Drug Metab Rev 2023; 55:428-440. [PMID: 37849071 DOI: 10.1080/03602532.2023.2271195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
Nebivolol is a beta-1 receptor blocker used to treat hypertension, heart failure, erectile dysfunction, vascular disease, and diabetes mellitus. This review investigated the data regarding pharmacokinetic (PK) parameters, drug-drug interactions, dextrorotatory (D), and levorotatory (L) stereoisomers of nebivolol. The articles related to the PK of nebivolol were retrieved by searching the five databases; Google Scholar, PubMed, Cochrane Library, ScienceDirect, and EBSCO. A total of 20 studies comprising plasma concentration-time profile data following the nebivolol's oral and intravenous (IV) administration were included. The area under the concentration-time curve from zero to infinity (AUC0-∞) was 15 times greater in poor metabolizers (PMs) than in extensive metabolizers (EMs). In hypertensive patients, L-nebivolol expressed a higher maximum plasma concentration (Cmax) than D-nebivolol, i.e. 2.5 ng/ml vs 1.2 ng/ml. The AUC0-∞ of nebivolol was 3-fold greater in chronic kidney disease (CKD). The clearance (CL) was increased in obese than in controls from 51.6 ± 11.6 L/h to 71.6 ± 17.4 L/h when 0.5 mg/ml IV solution was infused. Nebivolol showed higher Cmax, AUC0-∞ and half-life (t1/2) when co-administered with bupropion, duloxetine, fluvoxamine, paroxetine, lansoprazole, and fluoxetine. This concise review of nebivolol would be advantageous in assessing all PK parameters, which may be crucial for clinicians to avoid drug-drug interactions, prevent adverse drug events and optimize the dosage regimen in diseased patients diagnosed with hypertension and cardiovascular disorders.
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Affiliation(s)
- Nida Hanif
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, Allama Iqbal Campus, University of the Punjab, Lahore, Pakistan
| | - Abdul Majeed
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees Ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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3
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Hypertension and Type 2 Diabetes-The Novel Treatment Possibilities. Int J Mol Sci 2022; 23:ijms23126500. [PMID: 35742943 PMCID: PMC9224227 DOI: 10.3390/ijms23126500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
Elevated blood pressure and hyperglycaemia frequently coexist and are both components of metabolic syndrome. Enhanced cardiovascular risk is strongly associated with diabetes and the occurrence of hypertension. Both hypertension and type 2 diabetes, if treated inappropriately, lead to serious complications, increasing the mortality of patients and generating much higher costs of health systems. This is why it is of great importance to find the missing link between hypertension and diabetes development and to simultaneously search for drugs influencing these two disorders or even drugs aimed at their pathological bases. Standard antihypertensive therapy mainly focuses on blood pressure reduction, while novel drugs also possess a wide range of pleiotropic modes of actions, such as cardio- and nephroprotective properties or body weight reduction. These properties are especially desirable in a situation when type 2 diabetes coexists with hypertension. This review describes the connections between diabetes and hypertension development and briefly summarises the current knowledge regarding attempts to define targets for the treatment of high blood pressure in diabetic patients. It also describes the standard hypotensive drugs preferred in patients with type 2 diabetes, as well as novel drugs, such as finerenone, esaxerenone, sodium-glucose co-transporter-2 inhibitors, glucagon-like peptide-1 analogues and sacubitril/valsartan.
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Identification of the New Metabolite of Nebivolol Using Liquid Chromatography Coupled with High-Resolution Mass Spectrometry and Chemometrics. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27030763. [PMID: 35164027 PMCID: PMC8839339 DOI: 10.3390/molecules27030763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
In this study, the phase I hepatic metabolism pathway of a cardiovascular drug nebivolol was proposed on the basis of a human liver microsomes assay with the use of LC-HR-MS coupled with the chemometric method. Six biotransformation products were found with the assistance of chemometric analysis. Five of them were identified as the previously reported products of alicyclic hydroxylation and dihydroxylation, aromatic hydroxylation, as well as alicyclic oxidation of the parent compound. Moreover, one metabolite, not reported so far, was found to be a product of N-dealkylation of nebivolol-2-amino-1-(6-fluoro-3,4-dihydro-2H-1-benzopyran-2-yl)ethan-1-ol. The novel metabolite was submitted to an in silico toxicity analysis to assess its biological properties. The applied computational methods indicated a significantly elevated risk of its mutagenic activity, compared to the parent molecule. Several metabolites of the nebivolol described in the literature were not detected in this study, indicating their non-hepatic origin.
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Chan You S, Krumholz HM, Suchard MA, Schuemie MJ, Hripcsak G, Chen R, Shea S, Duke J, Pratt N, Reich CG, Madigan D, Ryan PB, Woong Park R, Park S. Comprehensive Comparative Effectiveness and Safety of First-Line β-Blocker Monotherapy in Hypertensive Patients: A Large-Scale Multicenter Observational Study. Hypertension 2021; 77:1528-1538. [PMID: 33775125 DOI: 10.1161/hypertensionaha.120.16402] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea (S.C.Y., R.W.P.).,Department of Preventive Medicine and Public Health (S.C.Y.), Yonsei University College of Medicine, Seoul, Korea
| | - Harlan M Krumholz
- Yale University School of Medicine, New Haven, CT (H.M.K.).,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.M.K.)
| | - Marc A Suchard
- Department of Biostatistics, Fielding School of Public Health (M.A.S., M.J.S.).,Department of Biomathematics, David Geffen School of Medicine at University of California, Los Angeles (M.A.S.)
| | - Martijn J Schuemie
- Department of Biostatistics, Fielding School of Public Health (M.A.S., M.J.S.).,Janssen Research and Development, Titusville, NJ (M.J.S., P.B.R.)
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY (G.H., R.C., S.S., P.B.R.).,Medical Informatics Services, New York-Presbyterian Hospital (G.H.)
| | - RuiJun Chen
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY (G.H., R.C., S.S., P.B.R.).,Department of Medicine, Weill Cornell Medical College, New York, NY (R.C.)
| | - Steven Shea
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY (G.H., R.C., S.S., P.B.R.).,Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (S.S.)
| | - Jon Duke
- Georgia Tech Research Institute, Georgia Tech College of Computing, Atlanta (J.D.)
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide (N.P.)
| | | | - David Madigan
- Department of Statistics, Columbia University, New York, NY (D.M.)
| | - Patrick B Ryan
- Janssen Research and Development, Titusville, NJ (M.J.S., P.B.R.).,Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY (G.H., R.C., S.S., P.B.R.)
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea (S.C.Y., R.W.P.).,Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea (R.W.P.)
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular Diseases (S.P.), Yonsei University College of Medicine, Seoul, Korea.,Section of Cardiovascular Medicine, Department of Medicine (S.P.)
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Cicero AFG, Kuwabara M, Borghi C. A Critical Review of Nebivolol and its Fixed-Dose Combinations in the Treatment of Hypertension. Drugs 2019; 78:1783-1790. [PMID: 30426333 DOI: 10.1007/s40265-018-0999-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
β-Adrenergic receptor blockers (β-blockers) are well-known useful and cost-effective drugs for managing hypertensive patients with coronary heart disease, stroke, and heart failure. However, it is often difficult to use β-blockers for patients with asthma or chronic obstructive pulmonary disease (COPD). Moreover, most β-blockers negatively influence glucose or lipid metabolism. Nebivolol is a third-generation lipophilic β-1 receptor-selective blocker with nitric oxide-mediated vasodilatory effects, metabolically neutral and usually well tolerated by patients with asthma or COPD. Nebivolol has significant effects of reduction in central blood pressure and improvements in endothelial dysfunction and arterial stiffness. To summarize the merits and demerits of nebivolol in different clinical situations, we conducted a review using the word 'nebivolol' on Pubmed and Embase, limiting the search to hypertension, clinical trials, and meta-analyses. This review summarizes the clinical studies on nebivolol itself and on the combination of nebivolol with other antihypertensive drugs, such as hydrochlorothiazide, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and amlodipine. Most studies showed the safety and well-tolerated profile of nebivolol and the combination of nebivolol with other antihypertensive drugs, which suggests that new fixed combinations of nebivolol with other antihypertensive drugs would be useful for patients who are unable to tolerate traditional β-blockers.
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Affiliation(s)
- Arrigo F G Cicero
- Medical and Surgical Sciences Department, S. Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
| | | | - Claudio Borghi
- Medical and Surgical Sciences Department, S. Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy.
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Olawi N, Krüger M, Grimm D, Infanger M, Wehland M. Nebivolol in the treatment of arterial hypertension. Basic Clin Pharmacol Toxicol 2019; 125:189-201. [DOI: 10.1111/bcpt.13248] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/02/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Nasima Olawi
- Department of Biomedicine, Pharmacology Aarhus University Aarhus C Denmark
| | - Marcus Krüger
- Clinic for Plastic, Aesthetic and Hand Surgery Otto von Guericke University Magdeburg Magdeburg Germany
| | - Daniela Grimm
- Department of Biomedicine, Pharmacology Aarhus University Aarhus C Denmark
- Clinic for Plastic, Aesthetic and Hand Surgery Otto von Guericke University Magdeburg Magdeburg Germany
| | - Manfred Infanger
- Clinic for Plastic, Aesthetic and Hand Surgery Otto von Guericke University Magdeburg Magdeburg Germany
| | - Markus Wehland
- Clinic for Plastic, Aesthetic and Hand Surgery Otto von Guericke University Magdeburg Magdeburg Germany
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8
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Zhou XY, Hu XX, Li MF, Wang H, Zhang LQ, Hu GX, Cai JP. Functional characterization of CYP2C19 variants in nebivolol 4-hydroxlation in vitro. Drug Test Anal 2017; 10:807-813. [PMID: 29098786 DOI: 10.1002/dta.2334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022]
Abstract
Cytochrome P450 2C19 (CYP2C19) allelic variants are thought to play an important part in inter-individual variability in drug metabolism. We evaluated the in vitro hydroxylation of nebivolol by 31 CYP2C19 alleles identified in a Chinese Han population recently. Wild-type CYP2C19*1B and 30 isoforms were highly expressed in insect cells, and the enzymatic activities of CYP2C19 variants towards nebivolol hydroxylation were characterized. Among the 30 CYP2C19 alleles, most of the recombinant CYP2C19 variants exhibited no or significantly low activity compared with CYP2C19*1B. Three variants, CYP2C19*29 (K28I), L16F, and CYP2C19*23 (G91R), showed increased intrinsic clearance of >140% CYP2C19*1B. Combined with a previous study on the effects of CYP2D6 variants on nebivolol metabolism, our comprehensive analyses on the enzymatic activities of CYP2C19 variants towards nebivolol in the present study may contribute to determination of the optimal doses of nebivolol for the treatment of hypertension and understanding of "individualized" medication.
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Affiliation(s)
- Xiao-Yang Zhou
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Xiao-Xia Hu
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meng-Fang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China.,Key Laboratory of Molecular Cardiology, Shaanxi, China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Shaanxi, China
| | - Hao Wang
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Li-Qun Zhang
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Guo-Xin Hu
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian-Ping Cai
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
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Stauffer BL, Dow CA, Diehl KJ, Bammert TD, Greiner JJ, DeSouza CA. Nebivolol, But Not Metoprolol, Treatment Improves Endothelial Fibrinolytic Capacity in Adults With Elevated Blood Pressure. J Am Heart Assoc 2017; 6:JAHA.117.007437. [PMID: 29122812 PMCID: PMC5721799 DOI: 10.1161/jaha.117.007437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vascular endothelial fibrinolytic function is impaired in adults with prehypertension and hypertension and plays a mechanistic role in the development of atherothrombotic events. The influence of β-blockers on endothelial fibrinolysis is unknown. This study compared the effects of chronic nebivolol and metoprolol treatment on endothelial tissue-type plasminogen activator (t-PA) release in adults with elevated blood pressure (BP). METHODS AND RESULTS Forty-four middle-aged adults (36% women) with elevated BP completed a 3-month, double-blind, randomized, placebo-controlled trial comparing nebivolol (5 mg/d), metoprolol succinate (100 mg/d), and placebo. Net endothelial t-PA release was determined in vivo in response to intrabrachial infusions of bradykinin and sodium nitroprusside before and after each intervention. In a subset, the dose-response curves to bradykinin and sodium nitroprusside were repeated with a coinfusion of the antioxidant vitamin C. At baseline, resting BP and endothelial t-PA release were comparable between the 3 groups. BP decreased to a similar extent (≈10 mm Hg) in the nebivolol- and metoprolol-treated groups. There was a substantial increase (≈30%; P<0.05) in the capacity of the endothelium to release t-PA following chronic treatment with nebivolol but not metoprolol or placebo. Mitigating oxidant stress with vitamin C coinfusion potentiated t-PA release (90%; P<0.05) at baseline in all groups. However, after the intervention, t-PA release was unchanged by vitamin C coinfusion in the nebivolol group only. CONCLUSIONS Nebivolol but not metoprolol improves endothelial t-PA release in adults with elevated BP. This may be an important vascular benefit of nebivolol. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01595516.
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Affiliation(s)
- Brian L Stauffer
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, Boulder, CO .,Department of Medicine, University of Colorado Denver, Aurora, CO.,Denver Health Medical Center, Denver, CO
| | - Caitlin A Dow
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, Boulder, CO
| | - Kyle J Diehl
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, Boulder, CO
| | - Tyler D Bammert
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, Boulder, CO
| | - Jared J Greiner
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, Boulder, CO
| | - Christopher A DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, Boulder, CO.,Department of Medicine, University of Colorado Denver, Aurora, CO
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10
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Salma A, Lutze HV, Schmidt TC, Tuerk J. Photolytic degradation of the β-blocker nebivolol in aqueous solution. WATER RESEARCH 2017; 116:211-219. [PMID: 28340419 DOI: 10.1016/j.watres.2017.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 06/06/2023]
Abstract
Nebivolol (NEB) is one of the top-sold prescription drugs belonging to the third generation of beta-blockers. However, so far, occurrence data in the environment are lacking. Within this study NEB has been found for the first time in effluent samples of wastewater treatment plants in Germany with an average concentration of 13 ng L-1. Its photodegradation behavior in the environment and in technical processes is largely unknown. To fill this gap, three different UV treatment procedures (UV-C at 254 nm, UV-B at 312 nm and UV-A at 365 nm) were investigated in three different matrices: pure water, pure water in presence of the hydroxyl radical (OH) scavenger tert.-butanol and real wastewater. No elimination was observed during UV-A treatment. In contrast, NEB degradation during UV-B and UV-C treatment followed pseudo first order reaction kinetics, with highest removal rate during UV-C treatment in pure water (k = 7.8 × 10-4 s-1). The rate constant for UV-C irradiation decreased to 2.9 × 10-4 s-1 in the presence of the OH scavenger and in the presence of the wastewater matrix. The rate constant for the UV-B lamp was 4.4 × 10-4 s-1, Three transformation products were identified after UV-B and UV-C photolytic degradation using high resolution mass spectrometry. The main photoreaction is the substitution of the fluorine atoms of NEB by hydroxyl groups. A photolytic cleavage of the CF bond can be excluded as the high bond dissociation energy of aromatic CF bonds (525 kJ mol-1), exceeds the energy of electromagnetic radiation applied in the present study (≥254 nm, i.e., max. 471 kJ E-1). The quantum yields for NEB degradation for the UV-C lamp achieved in pure water, the OH scavenged system and wastewater matrix were Φdeg = 0.53, 0.19 and 0.22, respectively. For UV-B Φdeg was 0.023 ± 0.003, noticeable differences in quantum yield were not found. The photooxidation involves reactive oxygen species such as superoxide and singlet oxygen. These oxidative species may be formed upon reaction of photo-excited NEB with oxygen.
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Affiliation(s)
- Alaa Salma
- Institut für Energie- und Umwelttechnik e. V., (IUTA, Institute of Energy and Environmental Technology), Bliersheimer Str. 58-60, D-47229, Duisburg, Germany; University Duisburg-Essen, Faculty of Chemistry, Instrumental Analytical Chemistry, Universitätsstr. 5, D-45141, Essen, Germany
| | - Holger V Lutze
- University Duisburg-Essen, Faculty of Chemistry, Instrumental Analytical Chemistry, Universitätsstr. 5, D-45141, Essen, Germany; IWW Water Centre, Moritzstr. 26, D-45476, Mülheim an der Ruhr, Germany; Centre for Water and Environmental Research (ZWU), University of Duisburg-Essen, Universitätsstr. 2, 45141, Essen, Germany
| | - Torsten C Schmidt
- University Duisburg-Essen, Faculty of Chemistry, Instrumental Analytical Chemistry, Universitätsstr. 5, D-45141, Essen, Germany; IWW Water Centre, Moritzstr. 26, D-45476, Mülheim an der Ruhr, Germany; Centre for Water and Environmental Research (ZWU), University of Duisburg-Essen, Universitätsstr. 2, 45141, Essen, Germany
| | - Jochen Tuerk
- Institut für Energie- und Umwelttechnik e. V., (IUTA, Institute of Energy and Environmental Technology), Bliersheimer Str. 58-60, D-47229, Duisburg, Germany; Centre for Water and Environmental Research (ZWU), University of Duisburg-Essen, Universitätsstr. 2, 45141, Essen, Germany.
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11
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Nebivolol suppresses cardiac ryanodine receptor-mediated spontaneous Ca2+ release and catecholaminergic polymorphic ventricular tachycardia. Biochem J 2016; 473:4159-4172. [PMID: 27623776 DOI: 10.1042/bcj20160620] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
Abstract
β-Blockers are a standard treatment for heart failure and cardiac arrhythmias. There are ∼30 commonly used β-blockers, representing a diverse class of drugs with different receptor affinities and pleiotropic properties. We reported that among 14 β-blockers tested previously, only carvedilol effectively suppressed cardiac ryanodine receptor (RyR2)-mediated spontaneous Ca2+ waves during store Ca2+ overload, also known as store overload-induced Ca2+ release (SOICR). Given the critical role of SOICR in arrhythmogenesis, it is of importance to determine whether there are other β-blockers that suppress SOICR. Here, we assessed the effect of other commonly used β-blockers on RyR2-mediated SOICR in HEK293 cells, using single-cell Ca2+ imaging. Of the 13 β-blockers tested, only nebivolol, a β-1-selective β-blocker with nitric oxide synthase (NOS)-stimulating action, effectively suppressed SOICR. The NOS inhibitor (N-nitro-l-arginine methyl ester) had no effect on nebivolol's SOICR inhibition, and the NOS activator (histamine or prostaglandin E2) alone did not inhibit SOICR. Hence, nebivolol's SOICR inhibition was independent of NOS stimulation. Like carvedilol, nebivolol reduced the opening of single RyR2 channels and suppressed spontaneous Ca2+ waves in intact hearts and catecholaminergic polymorphic ventricular tachycardia (CPVT) in the mice harboring a RyR2 mutation (R4496C). Interestingly, a non-β-blocking nebivolol enantiomer, (l)-nebivolol, also suppressed SOICR and CPVT without lowering heart rate. These data indicate that nebivolol, like carvedilol, possesses a RyR2-targeted action that suppresses SOICR and SOICR-evoked VTs. Thus, nebivolol represents a promising agent for Ca2+-triggered arrhythmias.
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12
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Preparation and characterization of nanofibrous sheets for enhanced oral dissolution of nebivolol hydrochloride. J Pharm Biomed Anal 2016; 129:224-228. [PMID: 27433987 DOI: 10.1016/j.jpba.2016.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 01/08/2023]
Abstract
Nebivolol-loaded electrospun nanofibrous sheets were prepared for the dissolution enhancement of the active with the aim of improving its oral bioavailability. Physicochemical characterization of nanofibers including differential scanning calorimetry, attenuated total reflectance Fourier transform infrared spectroscopy and positron annihilation lifetime spectroscopy were carried out in order to track the physicochemical changes related to the electrospinning process. The obtained results unanimously indicated the amorphous transition of nebivolol as a result of electrospinning, furthermore supramolecular ordering of chains of polyvinyl alcohol matrix could be revealed by positron annihilation lifetime spectroscopy. The crystalline-amorphous conversion of the active, along with the increased specific surface area of the nanofibers enabled rapid and complete dissolution. More than twice amount of active released from the fibrous sheets than from the commercial tablets. In contrast to the control tablets, the dissolution was complete and was not influenced by the pH of the applied media.
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Diehl KJ, Stauffer BL, Dow CA, Bammert TD, Brunjes DL, Greiner JJ, DeSouza CA. Chronic Nebivolol Treatment Suppresses Endothelin-1-Mediated Vasoconstrictor Tone in Adults With Elevated Blood Pressure. Hypertension 2016; 67:1196-204. [PMID: 27113048 DOI: 10.1161/hypertensionaha.115.06979] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/23/2016] [Indexed: 01/23/2023]
Abstract
UNLABELLED Endothelin-1 (ET-1) plays a major role in the pathophysiology of hypertension and its associated cardiovascular risk. We tested the hypothesis that chronic nebivolol treatment reduces ET-1-mediated vasoconstrictor tone in adult humans with elevated blood pressure (BP). Furthermore, reducing ET-1 vasoconstrictor activity contributes to the improvement in endothelial vasodilator function associated with nebivolol treatment. Forty-two middle-aged adults with elevated BP (systolic BP ≥130 mm Hg or diastolic BP ≥85 mm Hg) completed a 3-month, double-blind, randomized, placebo controlled trial: 14 received nebivolol (8 men/6 women; 5 mg per day); 14 received metoprolol succinate (9 men/5 women; 100 mg per day); and 14 received placebo (9 men/5 women). Forearm blood flow (plethysmography) responses to selective (BQ-123: 100 nmol/min; 60 minutes) and nonselective (BQ-123+BQ-788 [50 nmol/min]; 60 minutes) ET-1 receptor blockade, as well as acetylcholine (4.0, 8.0, and 16.0 μg per 100 mL of tissue per minute) in the absence and presence of nonselective ET-1 receptor blockade were determined before and after each treatment intervention. Forearm blood flow responses to BQ-123 and BQ-123+BQ-788 were similarly and significantly elevated (≈30% and 60%, respectively) from baseline in all 3 groups. Nebivolol, but not metoprolol or placebo, therapy resulted in a marked (≈25% and 45%; P<0.05) reduction in forearm blood flow response to BQ-123 and BQ-123+BQ-788. Moreover, after nebivolol therapy only, vasodilator response to acetylcholine was not significantly increased by ET-1 receptor blockade. These results demonstrate that nebivolol, but not metoprolol, treatment reduces ET-1-mediated vasoconstrictor tone in adult humans with elevated BP. In addition, nebivolol-induced reduction in ET-1-mediated vasoconstrictor tone underlies the favorable effects of this β-blocker on endothelial vasodilation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01395329.
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Affiliation(s)
- Kyle J Diehl
- From the Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder (K.J.D., B.L.S., C.A.D., T.D.B., D.L.B., J.J.G., C.A.D.); Department of Medicine, University of Colorado, Denver (B.L.S., C.A.D.); and Department of Medicine, Denver Health Medical Center, CO (B.L.S.)
| | - Brian L Stauffer
- From the Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder (K.J.D., B.L.S., C.A.D., T.D.B., D.L.B., J.J.G., C.A.D.); Department of Medicine, University of Colorado, Denver (B.L.S., C.A.D.); and Department of Medicine, Denver Health Medical Center, CO (B.L.S.)
| | - Caitlin A Dow
- From the Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder (K.J.D., B.L.S., C.A.D., T.D.B., D.L.B., J.J.G., C.A.D.); Department of Medicine, University of Colorado, Denver (B.L.S., C.A.D.); and Department of Medicine, Denver Health Medical Center, CO (B.L.S.)
| | - Tyler D Bammert
- From the Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder (K.J.D., B.L.S., C.A.D., T.D.B., D.L.B., J.J.G., C.A.D.); Department of Medicine, University of Colorado, Denver (B.L.S., C.A.D.); and Department of Medicine, Denver Health Medical Center, CO (B.L.S.)
| | - Danielle L Brunjes
- From the Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder (K.J.D., B.L.S., C.A.D., T.D.B., D.L.B., J.J.G., C.A.D.); Department of Medicine, University of Colorado, Denver (B.L.S., C.A.D.); and Department of Medicine, Denver Health Medical Center, CO (B.L.S.)
| | - Jared J Greiner
- From the Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder (K.J.D., B.L.S., C.A.D., T.D.B., D.L.B., J.J.G., C.A.D.); Department of Medicine, University of Colorado, Denver (B.L.S., C.A.D.); and Department of Medicine, Denver Health Medical Center, CO (B.L.S.)
| | - Christopher A DeSouza
- From the Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder (K.J.D., B.L.S., C.A.D., T.D.B., D.L.B., J.J.G., C.A.D.); Department of Medicine, University of Colorado, Denver (B.L.S., C.A.D.); and Department of Medicine, Denver Health Medical Center, CO (B.L.S.).
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Kim CH, Abelardo N, Buranakitjaroen P, Krittayaphong R, Lim CH, Park SH, Pham NV, Rogelio G, Wong B, Low LP. Hypertension treatment in the Asia-Pacific: the role of and treatment strategies with nebivolol. HEART ASIA 2016; 8:22-6. [PMID: 27326226 DOI: 10.1136/heartasia-2015-010656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/18/2016] [Indexed: 12/16/2022]
Abstract
Hypertension is a common disease, and hypertensive patients are at increased risk of cardiovascular events. The prevalence and socioeconomic burden of hypertension in the Asia-Pacific region are predicted to increase in the coming decades. Effective blood pressure lowering reduces overall cardiovascular morbidity and mortality in patients, yet doubt has been raised regarding the use of (mainly older generation) β-blockers as initial therapy in hypertension. Consequently, several international treatment guidelines do not recommend β-blockers for the treatment of hypertension. However, in contrast to first-generation and second-generation β-blockers, the third-generation, vasodilating β-blocker nebivolol has a considerably better metabolic, haemodynamic and side effect profile. In addition to providing effective blood pressure control similar to other β-blockers and drugs from other antihypertensive classes, nebivolol exerts a dual mechanism for increasing the bioavailability of the naturally occurring vasodilator nitric oxide. The clinical benefits and significance of enhancing nitric oxide levels in hypertensive patients have been shown in direct comparisons of nebivolol with other β-blockers. While β-blockers generally provide comparable blood pressure reductions, only nebivolol demonstrated enhanced vasodilation and blood flow by increasing the expression of endothelial nitric oxide synthase and therefore increasing nitric oxide release from the endothelium. In contrast to other β-blockers, therefore, it has been suggested that nebivolol has beneficial effects in several hypertensive subgroups due to its vasodilating properties. Considering the existing data, it may be timely for treatment guidelines to recommend third-generation vasodilating β-blockers as a first-line option for the pharmacotherapy of hypertension.
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Affiliation(s)
- Cheol-Ho Kim
- Department of Internal Medicine , Seoul National University , Seongnam-si , Korea
| | - Nelson Abelardo
- College of Medicine, University of the Philippines College of Medicine , Metro Manila , Philippines
| | | | | | - Chin Hock Lim
- C H Lim Cardiology Clinic, Mount Elizabeth Medical Centre , Singapore , Singapore
| | - Sung-Ha Park
- Division of Cardiology , Severance Cardiovascular Hospital-Yonsei University College of Medicine , Seoul , Korea
| | | | - Gregorio Rogelio
- Heart Institute, St. Luke's Medical Center Global City , Metro Manila , Philippines
| | - Bernard Wong
- Everhealth Medical Centre Limited , Hong Kong , Hong Kong
| | - Lip Ping Low
- Low Cardiology Clinic, Mount Elizabeth Medical Centre , Singapore , Singapore
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Santos AH, Casey MJ, Bucci CM, Rehman S, Segal MS. Nebivolol Effects on Nitric Oxide Levels, Blood Pressure, and Renal Function in Kidney Transplant Patients. J Clin Hypertens (Greenwich) 2015; 18:741-9. [DOI: 10.1111/jch.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Alfonso H Santos
- Division of Nephrology, Hypertension and Renal Transplantation; Department of Medicine; College of Medicine; University of Florida; Gainesville FL
| | - Michael J. Casey
- Division of Nephrology, Hypertension and Renal Transplantation; Department of Medicine; College of Medicine; University of Florida; Gainesville FL
| | - Charles M. Bucci
- Division of Nephrology, Hypertension and Renal Transplantation; Department of Medicine; College of Medicine; University of Florida; Gainesville FL
| | - Shehzad Rehman
- Division of Nephrology, Hypertension and Renal Transplantation; Department of Medicine; College of Medicine; University of Florida; Gainesville FL
| | - Mark S. Segal
- Division of Nephrology, Hypertension and Renal Transplantation; Department of Medicine; College of Medicine; University of Florida; Gainesville FL
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Al Khaja KAJ, Sequeira RP, Alkhaja AK, Damanhori AHH. Antihypertensive Drugs and Male Sexual Dysfunction. J Cardiovasc Pharmacol Ther 2015; 21:233-44. [DOI: 10.1177/1074248415598321] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/21/2015] [Indexed: 12/14/2022]
Abstract
Background: Published clinical practice guidelines have addressed antihypertensive therapy and sexual dysfunction (SD) in many different ways. Objective: In this systematic review, we evaluated guidelines that address antihypertensive drug-associated SD, guideline recommendations, and recent guideline trends. Methods: Thirty sets of guidelines for hypertension management in adults that had been published in the English language since 2000 were reviewed. The primary outcome measure was antihypertensive-associated SD potential, which was independently evaluated using specific questions by 2 authors in a nonblinded standardized manner. Results: Sexual dysfunctions associated with thiazide-class diuretics, β-blockers, and centrally acting sympathoplegics were addressed by half of the guidelines reviewed. There is no clarity on β-blockers and thiazide-class diuretics because one-third of the guidelines are vague about individual β-blockers and diuretics, and there is no statement on third-generation β-blockers and thiazide-like diuretics that can improve erectile function. The revised guidelines never use terms such as loss of libido, ejaculatory dysfunction, lack of orgasm, and priapism. Summary versions of guidelines are inadequate to reflect the key interpretation of the primary guidelines on SD associated with antihypertensives, even in the major guidelines that were updated recently. Therapeutic issues such as exploring SD in clinical history, assessing SD prior to and during treatment with antihypertensives, substituting the offending agents with alternatives that possess a better safety profile, intervening with phosphodiesterase-5 inhibitors, and avoiding the concomitant use of nitrovasodilators are superficially addressed by most guidelines, with the exception of 2013 European Society of Hypertension/European Society of Cardiology and Seventh Joint National Committee recommendations. Conclusion: Future guideline revisions, including both full and summary reports, should provide a balanced perspective on antihypertensive-related SD issues to improve the impact of hypertension treatment guidelines on patient care and quality of life.
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Affiliation(s)
- Khalid A. J. Al Khaja
- Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Reginald P. Sequeira
- Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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Chan PWH, Teo WT, Koh SWY, Lee BR, Ayers BJ, Ma DL, Leung CH. Silver Triflate Catalyzed Cyclopropyl Carbinol Rearrangement for Benzo[b]oxepine and 2H-Chromene Synthesis. European J Org Chem 2015. [DOI: 10.1002/ejoc.201500374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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BRICIU CORINA, NEAG MARIA, MUNTEAN DANA, BOCSAN CORINA, BUZOIANU ANCA, ANTONESCU OANA, GHELDIU ANAMARIA, ACHIM MARCELA, POPA ADINA, VLASE LAURIAN. Phenotypic differences in nebivolol metabolism and bioavailability in healthy volunteers. CLUJUL MEDICAL (1957) 2015; 88:208-13. [PMID: 26528073 PMCID: PMC4576779 DOI: 10.15386/cjmed-395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/22/2015] [Accepted: 03/30/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Nebivolol, a third-generation β-blocker, is subject to extensive first-pass metabolism and produces active β-blocking hydroxylated metabolites, like 4-OH-nebivolol. It is primarily a substrate of CYP2D6, a metabolic pathway that is under polymorphic genetic regulation. The objective of this study was to assess the metabolizer phenotype and to evaluate the interphenotype bioavailability and metabolism of nebivolol. MATERIAL AND METHODS Forty-three healthy volunteers were included in this open-label, non-randomized clinical trial and each volunteer received a single dose of 5 mg nebivolol. Non-compartmental pharmacokinetic analysis was performed to determine the pharmacokinetic parameters of nebivolol and its active metabolite. The phenotypic distribution was assessed based on the AUC (aria under the curve) metabolic ratio of nebivolol/4-OH-nebivolol and statistical analysis. An interphenotype comparison of nebivolol metabolism and bioavailability was performed based on the pharmacokinetic parameters of nebivolol and its active metabolite. RESULTS Nebivolol/4-OH-nebivolol AUC metabolic ratios were not characterized by a standard normal distribution. The unique distribution emphasized the existence of two groups and the 43 healthy volunteers were classified as follows: poor metabolizers (PMs)=3, extensive metabolizers (EMs)=40. The phenotype had a marked impact on nebivolol metabolism. The exposure to nebivolol was 15-fold greater for PMs in comparison to EMs. CONCLUSION 40 EMs and 3 PMs were differentiated by using the pharmacokinetic parameters of nebivolol and its active metabolite. The study highlighted the existence of interphenotype differences regarding nebivolol metabolism and bioavailability.
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Affiliation(s)
- CORINA BRICIU
- Department of Clinical Pharmacy, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - MARIA NEAG
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - DANA MUNTEAN
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - CORINA BOCSAN
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - ANCA BUZOIANU
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - OANA ANTONESCU
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - ANA-MARIA GHELDIU
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - MARCELA ACHIM
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - ADINA POPA
- Department of Clinical Pharmacy, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - LAURIAN VLASE
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Abstract
Hypertension has been recognized as an important health issue in the pediatric population over the past years. This emphasizes the need for an organized and effective plan for diagnosis and management. This review provides information to guide physicians through a structured approach to (1) screen children for hypertension during routine visits; (2) use normative blood pressure tables for diagnosis and classification; (3) perform a clinical evaluation to identify the presence of risk factors, comorbidities and/or target organ damage; and (4) initiate an individualized plan of care that includes follow-up blood pressure measurement, therapeutic lifestyle changes and - if necessary - pharmacological therapies.
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Chen S, Swallow E, Li N, Faust E, Kelley C, Xie J, Wu E. Economic benefits associated with beta blocker persistence in the treatment of hypertension: a retrospective database analysis. Curr Med Res Opin 2015; 31:615-22. [PMID: 25651483 DOI: 10.1185/03007995.2015.1013624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the association between medical costs and persistence with beta blockers among hypertensive patients, and to quantify persistence related medical cost differences with nebivolol, which is associated with improved tolerability, versus other beta blockers. METHODS Adults who initiated hypertension treatment with a beta blocker were identified from the MarketScan * claims database (2008-2012). Patients were classified based on their first beta blocker use: nebivolol, atenolol, carvedilol, metoprolol, and other beta blockers. Patients with compelling indications for atenolol, carvedilol or metoprolol (acute coronary syndrome and congestive heart failure) were excluded. Patients enrolled in health maintenance organization or capitated point of service insurance plans were also excluded. Persistence was defined as continuous use of the index drug (<60 day gap). The average effect of persistence on medical costs (2012 USD) was estimated using generalized linear models (GLMs). Regression estimates were used to predict medical cost differences associated with persistence between nebivolol and the other cohorts. RESULTS A total of 587,424 hypertensive patients met the inclusion criteria. Each additional month of persistence with any one beta blocker was associated with $152.51 in all-cause medical cost savings; continuous treatment for 1 year was associated with $1585.98 in all-cause medical cost savings. Patients treated with nebivolol had longer persistence during the 1 year study period (median: 315 days) than all other beta blockers (median: 156-292 days). Longer persistence with nebivolol translated into $305.74 all-cause medical cost savings relative to all other beta blockers. LIMITATIONS The results may not be generalizable to hypertensive patients with acute coronary syndrome or congestive heart failure. CONCLUSIONS Longer persistence with beta blockers for the treatment of hypertension was associated with lower medical costs. There may be greater cost savings due to better persistence with nebivolol than other beta blockers.
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Fisker FY, Grimm D, Wehland M. Third-Generation Beta-Adrenoceptor Antagonists in the Treatment of Hypertension and Heart Failure. Basic Clin Pharmacol Toxicol 2015; 117:5-14. [DOI: 10.1111/bcpt.12396] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/26/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Filip Y. Fisker
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus Denmark
| | - Daniela Grimm
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus Denmark
| | - Markus Wehland
- Clinic for Plastic, Aesthetic and Hand Surgery; Otto-von-Guericke-University Magdeburg; Magdeburg Germany
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Sullo MG, Perri D, Sibilio M, Rafaniello C, Fucile A, Rossi F, Capuano A. Hypoglycemia, polycythemia and hyponatremia in a newborn exposed to nebivolol during pregnancy. J Pharmacol Pharmacother 2015; 6:45-8. [PMID: 25709355 PMCID: PMC4319251 DOI: 10.4103/0976-500x.149148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/15/2014] [Accepted: 06/28/2014] [Indexed: 11/22/2022] Open
Abstract
Nebivolol is a third-generation beta blocker that exerts selective antagonistic activity on β1 receptors. It has vasodilating properties that result from direct stimulation of endothelial nitric oxide synthase. Nebivolol is indicated for the treatment of hypertension and heart failure, and is generally well tolerated. In this article, we report a case of an infant who was admitted to the Pediatrics and Neonatology Unit of the Moscati Hospital (Aversa, Italy) about 24 hours after birth. The reason for hospitalization was persistent severe hypoglycemia (blood glucose = 30 mg/dL) and jaundice (total bilirubin = 12.5 mg/dL, indirect bilirubin 11.75 mg/dL). He was born by spontaneous delivery after a normal term pregnancy. Birth weight was 3040 g and the Apgar score was 6-9. The mother reported taking nebivolol 5 mg/day for unspecified tachycardia in the last 4 months of pregnancy. Clinical and instrumental investigations carried out during hospitalization did not reveal any congenital or perinatal abnormalities. After treatment for metabolic and electrolyte imbalance, he was discharged on the 10th day of hospitalization, in good clinical condition and with normalization of clinical and laboratory parameters. Currently, there are no specific studies on nebivolol tolerability during pregnancy. Our data suggest that the risk profile of nebivolol during pregnancy is the same as that of other β-blockers. Therefore, further studies are required to determine the safety of β-blockers during pregnancy and the risks to the unborn child.
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Affiliation(s)
- Maria Giuseppa Sullo
- Department of Experimental Medicine, Section of Pharmacology, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Second University of Naples, Naples, Italy
| | - Domenico Perri
- Department of Pediatric, Moscati Hospital, Aversa, Italy
| | | | - Concetta Rafaniello
- Department of Experimental Medicine, Section of Pharmacology, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Second University of Naples, Naples, Italy
| | | | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Second University of Naples, Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Second University of Naples, Naples, Italy
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Jankovic SM. Pharmacokinetics of selective β1-adrenergic blocking agents: prescribing implications. Expert Opin Drug Metab Toxicol 2014; 10:1221-9. [DOI: 10.1517/17425255.2014.937702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Briciu C, Neag M, Muntean D, Vlase L, Bocsan C, Buzoianu A, Gheldiu AM, Achim M, Popa A. A pharmacokinetic drug interaction study between nebivolol and paroxetine in healthy volunteers. J Clin Pharm Ther 2014; 39:535-40. [PMID: 24845234 DOI: 10.1111/jcpt.12180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/23/2014] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Nebivolol is a highly selective beta-blocker with additional vasodilator properties, widely used in the clinical practice for the treatment of hypertension and heart failure. Paroxetine is a second-generation antidepressant and a potent inhibitor of CYP2D6, the same isoenzyme involved in the metabolism of nebivolol. The objective of this study was to investigate the effect of multiple-dose paroxetine intake on the pharmacokinetics of nebivolol in healthy volunteers and its potential consequences upon nebivolol pharmacodynamics. METHODS The study included 23 healthy subjects and was designed as an open-label, single-centre, non-randomized, two-period clinical trial. During period 1 (reference), each volunteer received a single dose of 5 mg nebivolol, whereas during period 2 (test), each volunteer received a single dose of 5 mg nebivolol and 20 mg paroxetine, after a pretreatment regimen with paroxetine (20-40 mg/day for 6 days). The pharmacokinetic parameters of nebivolol and its active metabolite were analysed by non-compartmental modelling. The pharmacodynamic parameters (blood pressure and heart rate) were assessed at rest, after each nebivolol intake. RESULTS AND DISCUSSION Pretreatment with paroxetine increased the mean peak plasma concentrations (Cmax ) for unchanged nebivolol (1·78 ± 1·17 vs. 4·24 ± 1·67 ng/mL) and for its active metabolite (0·58 ± 0·21 vs. 0·79 ± 0·24 ng/mL) compared to nebivolol alone. The time (tmax ) to reach Cmax was 1·37 ± 0·88 (h) and 3·11 ± 1·76 (h) for the parent compound and its active metabolite after nebivolol administered alone and 3·96 ± 1·76 (h), respectively, 7·33 ± 7·84 (h) after pretreatment with paroxetine. Also, the total areas under the curve (AUC0-∞ ) were significantly increased from 17·26 ± 43·06 to 106·20 ± 65·56 h ng/mL for nebivolol unchanged and 13·03 ± 11·29 to 74·56 ± 88·77 h ng/mL for its hydroxylated metabolite, before and after paroxetine intake. All the pharmacokinetic parameters presented statistically significant differences when paroxetine was administered with nebivolol. Nonetheless, statistical analysis did not show a significant difference between the vital signs measured during the two periods. WHAT IS NEW AND CONCLUSION After pretreatment with paroxetine, the exposure to nebivolol was increased by 6·1-fold for the parent drug and 5·7-fold for the hydroxylated active metabolite. Paroxetine influenced nebivolol pharmacokinetics in healthy volunteers, but it did not have a significant effect on nebivolol pharmacodynamic parameters measured at rest, although the clinical relevance of this drug interaction needs further investigation.
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Affiliation(s)
- C Briciu
- Faculty of Pharmacy, Department of Clinical Pharmacy, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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Nicolai MPJ, Liem SS, Both S, Pelger RCM, Putter H, Schalij MJ, Elzevier HW. A review of the positive and negative effects of cardiovascular drugs on sexual function: a proposed table for use in clinical practice. Neth Heart J 2014; 22:11-9. [PMID: 24155101 PMCID: PMC3890007 DOI: 10.1007/s12471-013-0482-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Several antihypertensive drugs, such as diuretics and β-blockers, can negatively affect sexual function, leading to diminished quality of life and often to noncompliance with the therapy. Other drug classes, however, such as angiotensin II receptor blockers (ARBs) are able to improve patients’ sexual function. Sufficient knowledge about the effects of these widely used antihypertensive drugs will make it possible for cardiologists and general practitioners to spare and even improve patients’ sexual health by switching to different classes of cardiac medication. Nevertheless, previous data (part I) indicate that most cardiologists lack knowledge about the effects cardiovascular agents can have on sexual function and will thus not be able to provide the necessary holistic patient care with regard to prescribing these drugs. To be able to improve healthcare on this point, we aimed to provide a practical overview, for use by cardiologists as well as other healthcare professionals, dealing with sexual dysfunction in their clinical practices. Therefore, a systematic review of the literature was performed. The eight most widely used classes of antihypertensive drugs have been categorised in a clear table, marking whether they have a positive, negative or no effect on sexual function.
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Affiliation(s)
- M P J Nicolai
- Department of Urology, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, the Netherlands,
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An update on targeted therapy in metastatic renal cell carcinoma. Urol Oncol 2012; 30:240-6. [DOI: 10.1016/j.urolonc.2009.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 12/19/2009] [Accepted: 12/22/2009] [Indexed: 11/19/2022]
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Raji IA, Mugabo P, Obikeze K. Effect of Tulbaghia violacea on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats. JOURNAL OF ETHNOPHARMACOLOGY 2012; 140:98-106. [PMID: 22222281 DOI: 10.1016/j.jep.2011.12.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 12/15/2011] [Accepted: 12/20/2011] [Indexed: 05/31/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tulbaghia violacea Harv. (Alliaceae) is a small bulbous herb which belongs to the family Alliaceae, most commonly associated with onions and garlic. In South Africa, this herb has been traditionally used in the treatment of various ailments, including fever, colds, asthma, paralysis, hypertension and stomach problems. The aim of this study was to evaluate the effect of methanol leaf extracts (MLE) of Tulbaghia violacea on the blood pressure (BP) and heart rate (HR) in anaesthetized male spontaneously hypertensive rats; and to find out the mechanism(s) by which it acts. MATERIALS AND METHODS The MLE of Tulbaghia violacea (5-150mg/kg), angiotensin I human acetate salt hydrate (ang I, 3.1-100μg/kg), angiotensin II human (ang II, 3.1-50μg/kg), phenylephrine hydrochloride (phenylephrine, 0.01-0.16mg/kg) and dobutamine hydrochloride (dobutamine, 0.2-10.0μg/kg) were infused intravenously, while the BP and HR were measured via a pressure transducer connecting the femoral artery and the Powerlab. RESULTS Tulbaghia violacea significantly (p<0.01) reduced the systolic, diastolic, and mean arterial BP; and HR dose-dependently. Ang I, ang II, phenylephrine and dobutamine all increased the BP dose-dependently. The hypertensive effect of ang I and the HR-increasing effect of dobutamine were significantly (p<0.01) decreased by their co-infusion with Tulbaghia violacea (60mg/kg). However, the co-infusion of ang II or phenylephrine with Tulbaghia violacea (60mg/kg) did not produce any significant change in BP or HR when compared to the infusion of either agent alone in the same animal. CONCLUSIONS Tulbaghia violacea reduced BP and HR in the SHR. The reduction in BP may be due to actions of the MLE on the ang I converting enzyme (ACE) and β(1) adrenoceptors.
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Affiliation(s)
- Ismaila A Raji
- Discipline of Pharmacology, School of Pharmacy, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa.
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Sun P, Chang J, Zhang J, Kahler KH. Evolutionary cost analysis of valsartan initiation among patients with hypertension: a time series approach. J Med Econ 2012; 15:8-18. [PMID: 22011107 DOI: 10.3111/13696998.2011.626097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study examines the evolutionary impact of valsartan initiation on medical costs. METHODS A retrospective time series study design was used with a large, US national commercial claims database for the period of 2004-2008. Hypertensive patients who initiated valsartan between the ages of 18 and 63, and had continuous enrollment for 24-month pre-initiation period and 24-month post-initiation period were selected. Patients' monthly medical costs were calculated based on individual claims. A novel time series model was devised with monthly medical costs as its dependent variables, autoregressive integrated moving average (ARIMA) as its stochastic components, and four indicative variables as its decomposed interventional components. The number of post-initiation months before a cost-offset point was also assessed. RESULTS Patients (n = 18,269) had mean age of 53 at the initiation date, and 53% of them were female. The most common co-morbid conditions were dyslipidemia (52%), diabetes (24%), and hypertensive complications (17%). The time series model suggests that medical costs were increasing by approximately $10 per month (p < 0.01) before the initiation, and decreasing by approximately $6 per month (p < 0.01) after the initiation. After the 4th post-initiation month, medical costs for patients with the initiation were statistically significantly lower (p < 0.01) than forecasted medical costs for the same patients without the initiation. LIMITATIONS The study has its limitations in data representativeness, ability to collect unrecorded clinical conditions, treatments, and costs, as well as its generalizability to patients with different characteristics. CONCLUSIONS Commercially insured hypertensive patients experienced monthly medical cost increase before valsartan initiation. Based on our model, the evolutionary impact of the initiation on medical costs included a temporary cost surge, a gradual, consistent, and statistically significant cost decrease, and a cost-offset point around the 4th post-initiation month.
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Affiliation(s)
- Peter Sun
- Kailo Research Group, Fishers, IN 46038, USA.
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Affiliation(s)
- Nicoletta Riva
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK
| | - Gregory YH Lip
- University of Birmingham, City Hospital, Centre for Cardiovascular Sciences, Birmingham B18 7QH, UK ;
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Karavitakis M, Komninos C, Theodorakis PN, Politis V, Lefakis G, Mitsios K, Koritsiadis S, Doumanis G. Evaluation of Sexual Function in Hypertensive Men Receiving Treatment: A Review of Current Guidelines Recommendation. J Sex Med 2011; 8:2405-14. [DOI: 10.1111/j.1743-6109.2011.02342.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Effect of nebivolol vs. hydrochlorothiazide on the walking capacity in hypertensive patients with intermittent claudication. J Hypertens 2011; 29:1448-56. [DOI: 10.1097/hjh.0b013e3283471151] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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HUSTED JANICEA, TOM BRIAND, FAREWELL VERNONT, GLADMAN DAFNAD. Longitudinal Analysis of Fatigue in Psoriatic Arthritis. J Rheumatol 2010; 37:1878-84. [DOI: 10.3899/jrheum.100179] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To describe the longitudinal course of fatigue in psoriatic arthritis (PsA).Methods.Our study included 390 patients who attended the University of Toronto Psoriatic Arthritis Clinic between 1998 and 2006 and who completed 2 or more administrations of the modified Fatigue Severity Scale (mFSS) at yearly intervals. Clinical data were used that corresponded to visits in which mFSS was administered. We used linear mixed effects models to examine the relationships of disease-related and nondisease-related variables with mFSS scores across multiple clinic visits, and linear regression models to investigate the association between change in mFSS scores (ΔmFSS) and changes in covariates between visits.Results.Clinical measures of disease activity were related to fatigue over time; however, these relationships disappeared in the context of patient-reported physical disability and pain. Patient-reported measures of physical disability, pain, and psychological distress were most closely related to higher mFSS scores (greater fatigue) across clinic assessments. Fatigue was found to vary over time, at least when assessed at yearly intervals. In general, measures of clinical and functional status at the current visit were more predictive of ΔmFSS in between previous and current visits than change scores in these measures between visits. Comorbid fibromyalgia or hypertension were also associated with greater fatigue across multiple visits and with change in fatigue between visits.Conclusion.A combination of factors is associated with fatigue in PsA. The full effect of comorbidities on fatigue warrants further study to better understand the effective management of fatigue in PsA.
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Current world literature. Curr Opin Cardiol 2010; 25:411-21. [PMID: 20535070 DOI: 10.1097/hco.0b013e32833bf995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lipsic E, van Veldhuisen DJ. Nebivolol in chronic heart failure: current evidence and future perspectives. Expert Opin Pharmacother 2010; 11:983-92. [PMID: 20307222 DOI: 10.1517/14656561003694650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Chronic activation of the sympathetic nervous system leads to deterioration of cardiovascular function in heart failure patients. In systolic heart failure, beta-blockers were proven to be effective in decreasing the number of deaths and improving morbidity. However, beta-blockers are a heterogeneous drug group, consisting of agents with different selectivity for adrenergic receptors and/or additional effects in heart or peripheral circulation. AREAS COVERED IN THE REVIEW We describe the role of the sympathetic nervous system, beta-blockers and specifically nebivolol in chronic heart failure. WHAT THE READER WILL GAIN Nebivolol is a third-generation beta-blocker, with high beta(1)/beta(2) selectivity. Moreover, it has important vasodilating properties, by stimulating the production of nitric oxide. Smaller studies have already shown beneficial effects of nebivolol treatment on surrogate end points in heart failure patients. The recently published SENIORS (Phase III) study in an elderly heart failure population demonstrated a decreased number of clinical events in patients treated with nebivolol. Importantly, this effect was observed in patients with both impaired and preserved left ventricular systolic function. TAKE HOME MESSAGE Specific beta-blockers may have distinct effects in various subgroups of heart failure patients. So far, nebivolol is the only beta-blocker to have been shown effective in elderly heart failure patients, regardless of their left ventricular ejection fraction.
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Affiliation(s)
- Erik Lipsic
- University Medical Center Groningen, Thoraxcenter, Department of Cardiology, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
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