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Martinez A, Lakkimsetti M, Maharjan S, Aslam MA, Basnyat A, Kafley S, Reddy SS, Ahmed SS, Razzaq W, Adusumilli S, Khawaja UA. Beta-Blockers and Their Current Role in Maternal and Neonatal Health: A Narrative Review of the Literature. Cureus 2023; 15:e44043. [PMID: 37746367 PMCID: PMC10517705 DOI: 10.7759/cureus.44043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Beta-blockers are a class of medications that act on beta-adrenergic receptors and are categorized as cardio-selective and non-selective. They are principally used to treat cardiovascular conditions such as hypertension and arrhythmias. Beta-blockers have also been used to treat non-cardiogenic indications in non-pregnant individuals and the pediatric population. In pregnancy, labetalol is the mainstay treatment for hypertension and other cardiovascular indications. However, contraindications to certain sub-types of beta-blockers include bradycardia, heart failure, obstructive lung diseases, and hemodynamic instability. There is conflicting evidence of the adverse effects on fetal and neonatal health due to a scarce safety and efficacy profile, and further studies are necessary to understand the pharmacokinetics of the different classes of beta-blockers in pregnancy and fetal health. Understanding the hemodynamic changes during the stages of pregnancy is important to target a more beneficial therapy for both mother and fetus as well as better neonatal outcomes. Beta-blocker use in the pediatric population is less documented in studies but does have the potential to treat various cardiogenic and non-cardiogenic conditions. Future comprehensive studies would further benefit the direction of beta-blocker treatment during pregnancy in neonates and pediatrics.
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Affiliation(s)
- Andrea Martinez
- Medical School, Universidad Autonoma de Guadalajara, Zapopan, MEX
| | | | - Sameep Maharjan
- General Practice, Patan Academy of Health Sciences, Kathmandu, NPL
| | - Muhammad Ammar Aslam
- Medical School, Sargodha Medical College, University of Health Sciences, Sargodha, PAK
| | - Anouksha Basnyat
- General Practice, Hospital for Advanced Medicine & Surgery (HAMS), Kathmandu, NPL
| | - Shashwat Kafley
- Medical School, Enam Medical College and Hospital, Dhaka, BGD
| | | | - Saima S Ahmed
- Vascular Surgery, Dow International Medical College, Karachi, PAK
| | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
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Baou K, Katsi V, Makris T, Tousoulis D. Beta Blockers and Chronic Obstructive Pulmonary Disease (COPD): Sum of Evidence. Curr Hypertens Rev 2020; 17:196-206. [PMID: 33302840 DOI: 10.2174/1573402116999201209203250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
Approximately, half a century has passed since the discovery of beta blockers. Then, their prime therapeutic purpose was to treat angina and cardiac arrhythmias, nowadays, beta blockers' usage and effectiveness is extended to treat other cardiovascular diseases, such as hypertension, congestive heart failure, and coronary artery disease. Safety concerns were raised about beta blockers and their use for chronic obstructive pulmonary disease (COPD) patients with concurrent cardiovascular disease. After a thorough research of the literature, this review summarizes the evidence proving that beta blockers not only might be well tolerated in COPD patients, but they might also have a beneficial effect in this group of patients.
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Affiliation(s)
- Katerina Baou
- First Department of Pulmonary Medicine, Sismanoglio Hospital, Sismanogliou 1, Marousi,. Greece
| | - Vasiliki Katsi
- First Department of Cardiology, Hippokration Hospital, University of Athens, Vasilissis Sofias 114, Athens,. Greece
| | - Thomas Makris
- Department of Cardiology, Helena Venizelou Hospital, Helenas Venizelou 2 Square, Ampelokipi,. Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, University of Athens, Vasilissis Sofias 114, Athens,. Greece
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Mannam MR, S. S, Kumar P, Chamarthi NR, K. R. S. P. Synthesis of novel 3-[(2R*)-2-[(2S*)-6-fluoro-3,4-dihydro-2H-chromen-2-yl]-2-hydroxyethyl]-urea/thiourea derivatives and evaluation of their antimicrobial activities. PHOSPHORUS SULFUR 2019. [DOI: 10.1080/10426507.2019.1635596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Madhava Rao Mannam
- Department of Chemistry, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Andhra Pradesh, India
- Chemical Research Division, API R&D Centre, Micro Labs Ltd, Bangalore, India
| | - Srimurugan S.
- Chemical Research Division, API R&D Centre, Micro Labs Ltd, Bangalore, India
| | - Pramod Kumar
- Chemical Research Division, API R&D Centre, Micro Labs Ltd, Bangalore, India
| | - Naga Raju Chamarthi
- Department of Chemistry, Sri Venkateswara University, Tirupathi, Andhra Pradesh, India
| | - Prasad K. R. S.
- Department of Chemistry, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Andhra Pradesh, India
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Khaskel A, Barman P, Maiti SK, Jana U. Nebivolol nanoparticles: a first catalytic use in Biginelli and Biginelli-like reactions. CAN J CHEM 2018. [DOI: 10.1139/cjc-2017-0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Herein, we report the catalytic activity of nebivolol nanoparticles a novel organocatalyst for the synthesis of DHPMs and DHPM-5-carboxamides. The nanoparticles are confirmed by DSC, TEM, AFM, and IR spectroscopy. The catalyst can be readily recovered and reused for the next four runs without any significant impact on the yields of the products. The products are fully characterized by FTIR, 1H NMR, 13C NMR, and distortionless enhanced polarization transfer (DEPT) NMR. The methodology adopted here offers several advantages such as solvent-free reaction, low loading of catalyst, short reaction times, and quantifiable yields.
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Affiliation(s)
- Anamika Khaskel
- Department of Chemistry, National Institute of Technology, Silchar 788010, Assam, India
| | - Pranjit Barman
- Department of Chemistry, National Institute of Technology, Silchar 788010, Assam, India
| | - Subir Kumar Maiti
- Department of Chemistry, National Institute of Technology, Silchar 788010, Assam, India
| | - Utpal Jana
- School of Pharmacy, Chouksey Engineering College, Lal Khadan, NH-49, Bilaspur 495004, India
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Cseplo P, Vamos Z, Ivic I, Torok O, Toth A, Koller A. The Beta-1-Receptor Blocker Nebivolol Elicits Dilation of Cerebral Arteries by Reducing Smooth Muscle [Ca2+]i. PLoS One 2016; 11:e0164010. [PMID: 27716772 PMCID: PMC5055296 DOI: 10.1371/journal.pone.0164010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 09/19/2016] [Indexed: 01/22/2023] Open
Abstract
Rationale Nebivolol is known to have beta-1 blocker activity, but it was also suggested that it elicits relaxation of the peripheral arteries in part via release of nitric oxide (NO). However, the effect of nebivolol on the vasomotor tone of cerebral arteries is still unclear. Objective To assess the effects of nebivolol on the diameter of isolated rat basilar arteries (BA) in control, in the presence of inhibitors of vasomotor signaling pathways of know action and hemolysed blood. Methods and Results Vasomotor responses were measured by videomicroscopy and the intracellular Ca2+ by the Fura-2 AM ratiometric method. Under control conditions, nebivolol elicited a substantial dilation of the BA (from 216±22 to 394±20 μm; p<0.05) in a concentration-dependent manner (10−7 to 10−4 M). The dilatation was significantly reduced by endothelium denudation or by L-NAME (inhibitor of NO synthase) or by SQ22536 (adenylyl cyclase blocker). Dilatation of BA was also affected by beta-2 receptor blockade with butoxamine, but not by the guanylate cyclase blocker ODQ. Interestingly, beta-1 blockade by atenolol inhibited nebivolol-induced dilation. Also, the BKCa channel blocker iberiotoxin and KCa channel inhibitor TEA significantly reduced nebivolol-induced dilation. Nebivolol significantly reduced smooth muscle Ca2+ level, which correlated with the increases in diameters and moreover it reversed the hemolysed blood-induced constriction of BA. Conclusions Nebivolol seems to have an important dilator effect in cerebral arteries, which is mediated via several vasomotor mechanisms, converging on the reduction of smooth muscle Ca2+ levels. As such, nebivolol may be effective to improve cerebral circulation in various diseased conditions, such as hemorrhage.
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Affiliation(s)
- Peter Cseplo
- Institute for Translational Medicine and Szentagothai Research Centre, University of Pecs, Medical School, Pecs, Hungary.,Department of Central Anesthesiology and Intensive Therapy, Petz Aladar County Teaching Hospital, Gyor, Hungary
| | - Zoltan Vamos
- Institute for Translational Medicine and Szentagothai Research Centre, University of Pecs, Medical School, Pecs, Hungary.,Department of Anaesthesiology and Intensive Therapy, University of Pecs, Medical School, Pecs, Hungary
| | - Ivan Ivic
- Institute for Translational Medicine and Szentagothai Research Centre, University of Pecs, Medical School, Pecs, Hungary.,Department of Anatomy, University of Pecs, Medical School, Pecs, Hungary
| | - Orsolya Torok
- Institute for Translational Medicine and Szentagothai Research Centre, University of Pecs, Medical School, Pecs, Hungary
| | - Attila Toth
- Institute of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Akos Koller
- Institute for Translational Medicine and Szentagothai Research Centre, University of Pecs, Medical School, Pecs, Hungary.,Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary.,Department of Physiology, New York Medical College, Valhalla, New York, United States of America.,Institute of Natural Sciences, University of Physical Education, Budapest, Hungary
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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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Ali I, Suhail M, Lone MN, Alothman ZA, Alwarthan A. Chiral resolution of multichiral center racemates by different modalities of chromatography. J LIQ CHROMATOGR R T 2016. [DOI: 10.1080/10826076.2016.1152582] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Imran Ali
- Department of Chemistry, Jamia Millia Islamia Central University, New Delhi, India
| | - Mohd Suhail
- Department of Chemistry, Jamia Millia Islamia Central University, New Delhi, India
| | - Mohammad Nadeem Lone
- Department of Chemistry, Jamia Millia Islamia Central University, New Delhi, India
| | - Zeid A. Alothman
- Department of Chemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Alwarthan
- Department of Chemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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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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Ali I, Suhail M, Al-Othman ZA, Alwarthan A, Aboul-Enein HY. Enantiomeric resolution of multiple chiral centres racemates by capillary electrophoresis. Biomed Chromatogr 2016; 30:683-94. [PMID: 26840015 DOI: 10.1002/bmc.3691] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 11/11/2022]
Abstract
Enantiomeric resolution of multichiral centre racemates is an important area as some multichiral centre racemates are of great medicinal importance. However, enantioseparation of such types of racemates is a challenging task. Amongst many analytical techniques, capillary electrophoresis is a powerful technique and may be used to resolve such racemates. Only few papers are available describing enantiomeric resolution of such racemates. Therefore, efforts have been made to describe the enantiomeric resolution of multichiral centre racemates by capillary electrophoresis. This article discusses the importance of multichiral racemates, the need for capillary electrophoresis in enantiomeric resolution and chiral resolution of multichiral centre racemates using various chiral selectors. Further, attempts have been made to discuss the future challenges and prospects of enantiomeric resolution of multichiral racemates. The various chiral selectors used for the purpose are chiral crown ether, cyclodextrins, polysaccharides, macrocyclic glycopeptide antibiotics and ligand exchange.
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Affiliation(s)
- Imran Ali
- Department of Chemistry, Jamia Millia Islamia (Central University), New Delhi, 110025, India
| | - Mohd Suhail
- Department of Chemistry, Jamia Millia Islamia (Central University), New Delhi, 110025, India
| | - Zeid A Al-Othman
- Department of Chemistry, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Abdulrahman Alwarthan
- Department of Chemistry, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Hassan Y Aboul-Enein
- Pharmaceutical and Medicinal Chemistry Department, Pharmaceutical and Drug Industries Research Division, National Research Centre, Dokki, Cairo, 12311, Egypt
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Kim DW, Maqusood Alam M, Lee YH, Khan MNA, Zhang Y, Lee YS. An efficient and practical enantiospecific synthesis of methyl chromanone- and chroman-2-carboxylates. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.tetasy.2015.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Formulation and in vitro evaluation of bilayer tablets of nebivolol hydrochloride and nateglinide for the treatment of diabetes and hypertension. JOURNAL OF DRUG DELIVERY 2015; 2015:827859. [PMID: 25648606 PMCID: PMC4310311 DOI: 10.1155/2015/827859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 11/18/2022]
Abstract
Diabetes mellitus (DM) and hypertension are two common diseases that often coexist. The most common cause of death in the diabetic patient is heart disease. In the present investigation we combine Nebivolol and Nateglinide for better patient compliance. IR layer was formulated using various superdisintegrants like Crospovidone, Croscarmellose sodium, and sodium starch glycolate and SR layer was formulated using polymers and gums like HPMC E15, ethyl cellulose, Gaur gum, and Xanthan gum. The disintegration and dissolution study of both layers showed that inclusion of surfactant (sodium lauryl sulphate) to the tablet formulation (IR) and dissolution medium (SR) enhanced the release of drugs from both layers. Kinetic studies of optimized IR layer (NBL8) and SR layer (N9) showed good linearity with regression coefficient of 0.9714 (Higuchi model) and 0.9931 (zero order kinetics), respectively. The above results reveal that the optimized IR layer of Nebivolol (NBL8) and SR layer of Nateglinide (N9) might be suitable for the treatment of diabetes and hypertension by sequential release of the two drugs in a bilayer tablet. IR-immediate release, SR-sustain release, NBL8-Nebivolol 8, N9-Nateglinide 9.
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Sanaee F, Valente Neves D, Lanchote VL, Jamali F. Pharmacokinetics of nebivolol in the rat: low oral absorption, loss in the gut and systemic stereoselectivity. Biopharm Drug Dispos 2013; 34:312-20. [DOI: 10.1002/bdd.1847] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 03/19/2013] [Accepted: 04/23/2013] [Indexed: 01/24/2023]
Affiliation(s)
- Forugh Sanaee
- Faculty of Pharmacy and Pharmaceutical Sciences; University of Alberta; Edmonton; Alberta; Canada
| | - Daniel Valente Neves
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto; Universidade e São Paulo Ribeirão Preto; Brazil
| | - Vera Lucia Lanchote
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto; Universidade e São Paulo Ribeirão Preto; Brazil
| | - Fakhreddin Jamali
- Faculty of Pharmacy and Pharmaceutical Sciences; University of Alberta; Edmonton; Alberta; Canada
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Song XG, Zhu SF, Xie XL, Zhou QL. Enantioselective Copper-Catalyzed Intramolecular Phenolic OH Bond Insertion: Synthesis of Chiral 2-Carboxy Dihydrobenzofurans, Dihydrobenzopyrans, and Tetrahydrobenzooxepines. Angew Chem Int Ed Engl 2013. [DOI: 10.1002/ange.201209455] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Song XG, Zhu SF, Xie XL, Zhou QL. Enantioselective Copper-Catalyzed Intramolecular Phenolic OH Bond Insertion: Synthesis of Chiral 2-Carboxy Dihydrobenzofurans, Dihydrobenzopyrans, and Tetrahydrobenzooxepines. Angew Chem Int Ed Engl 2013; 52:2555-8. [DOI: 10.1002/anie.201209455] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Indexed: 11/05/2022]
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Del Sindaco D, Tinti MD, Monzo L, Pulignano G. Clinical and economic aspects of the use of nebivolol in the treatment of elderly patients with heart failure. Clin Interv Aging 2010; 5:381-93. [PMID: 21152240 PMCID: PMC2998246 DOI: 10.2147/cia.s4482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Heart failure is a common and disabling condition with morbidity and mortality that increase dramatically with advancing age. Large observational studies, retrospective subgroup analyses and meta-analyses of clinical trials in systolic heart failure, and recently published randomized studies have provided data supporting the use of beta-blockers as a baseline therapy in heart failure in the elderly. Despite the available evidence about beta-blockers, this therapy is still less frequently used in elderly compared to younger patients. Nebivolol is a third-generation cardioselective beta-blocker with L-arginine/nitric oxide-induced vasodilatory properties, approved in Europe and several other countries for the treatment of essential hypertension, and in Europe for the treatment of stable, mild, or moderate chronic heart failure, in addition to standard therapies in elderly patients aged 70 years old or older. The effects of nebivolol on left ventricular function in elderly patients with chronic heart failure (ENECA) and the study of effects of nebivolol intervention on outcomes and rehospitalization in seniors with heart failure (SENIORS) have been specifically aimed to assess the efficacy of beta-blockade in elderly heart failure patients. The results of these two trials demonstrate that nebivolol is well tolerated and effective in reducing mortality and morbidity in older patients, and that the beneficial clinical effect is present also in patients with mildly reduced ejection fraction. Moreover, nebivolol appears to be significantly cost-effective when prescribed in these patients. However, further targeted studies are needed to better define the efficacy as well as safety profile in frail and older patients with comorbid diseases.
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Affiliation(s)
- Donatella Del Sindaco
- Heart Failure Unit, Division of Cardiology, INRCA Institute of Care and Research for Elderly, Rome, Italy.
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de Boer RA, Doehner W, van der Horst ICC, Anker SD, Babalis D, Roughton M, Coats AJ, Flather MD, van Veldhuisen DJ. Influence of diabetes mellitus and hyperglycemia on prognosis in patients > or =70 years old with heart failure and effects of nebivolol (data from the Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with heart failure [SENIORS]). Am J Cardiol 2010; 106:78-86.e1. [PMID: 20609652 DOI: 10.1016/j.amjcard.2010.02.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 02/07/2010] [Accepted: 02/07/2010] [Indexed: 11/17/2022]
Abstract
The beneficial effects of beta blockers in younger patients with heart failure (HF) due to systolic dysfunction are well established. However, data from patients > or =70 years old with diabetes mellitus and HF are lacking. The Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with heart failure [SENIORS] tested the efficacy of the vasodilator beta blocker nebivolol in patients > or =70 years old with HF and impaired or preserved left ventricular ejection fraction. In the present analysis, we evaluated the association between diabetes mellitus and baseline glucose levels on the primary outcome (all-cause mortality and cardiovascular hospitalization) and secondary end points, including all-cause mortality, cardiovascular hospitalizations, and cardiovascular mortality. Of 2,128 patients, 555 (26.1%) had diabetes mellitus. Of the 555 patients with diabetes mellitus, 223 (40.2%) experienced the primary end point compared to 484 (30.8%) of the 1,573 nondiabetic patients (p <0.001). For the nondiabetic patients, the rate of the primary outcome for placebo compared to nebivolol was 33.7% for the placebo group and 27.8% for the nebivolol group (hazard ratio 0.78, 95% confidence interval 0.65 to 0.93; p = 0.006). In the diabetic subset, the rate was 40.3% for the placebo group and 40.1% for the nebivolol group (hazard ratio 1.04, 95% confidence interval 0.80 to 1.35, p = 0.773). The subgroup interaction p value was 0.073. The baseline glucose levels in the nondiabetic patients did not significantly affect the outcomes. The effect of diabetes mellitus on outcome was independent of the left ventricular ejection fraction and was most pronounced in those with HF due to a nonischemic etiology. In conclusion, in patients > or =70 years old with HF, diabetes mellitus was associated with a worse prognosis. Nebivolol was less effective in the patients with diabetes and HF than in those with HF but without diabetes who were > or =70 years old.
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Affiliation(s)
- Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands.
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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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Abstract
The pharmacological control of arterial hypertension is a very frequent issue in clinical practice and some critical aspects can arise in particular circumstances and with particular molecules. In the case of hypertensive subjects with respiratory comorbidities, when first introduced, these beta-adrenergic receptor antagonists were described as affecting airway patency as a result of their antagonism against beta(2)-adrenergic receptors within airway muscles. New molecules with a better respiratory tolerability were subsequently designed in order to overcome the narrow therapeutic window of first-generation beta-adrenergic receptor antagonists. Nebivolol is a third-generation beta-adrenergic receptor antagonist with high beta(1)-selective adrenergic receptor antagonism and vasodilating properties that induces a substantial decrease of arterial pressure in hypertensive subjects while preserving their left ventricular function. Respiratory effects of nebivolol have been investigated in animal models, in healthy volunteers and in clinical trials carried out on patients suffering from bronchial asthma and chronic obstructive pulmonary disease (COPD). In contrast to older compounds, nebivolol, which modulates the endogenous production of nitric oxide and affects oxidative cascade, proved clinically well tolerated in terms of respiratory outcomes in this type of subject. Moreover, due to the substantial dissociation between its cardiac and pulmonary activity, nebivolol confirmed a very good safety profile when regularly administered to hypertensive subjects with obstructive respiratory comorbidities.
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Affiliation(s)
- Roberto Dal Negro
- Lung Department, Orlandi General Hospital, Bussolengo, Verona, Italy.
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Nebivolol induces parallel improvement of left ventricular filling pressure and coronary flow reserve in uncomplicated arterial hypertension. J Hypertens 2009; 27:2108-15. [DOI: 10.1097/hjh.0b013e32832ea925] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kemp DW, Brown JN, Tofade TS. Recent Advances in Pharmacotherapy. J Pharm Pract 2009. [DOI: 10.1177/0897190008330197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many unique and clinically important medications were approved by the Food and Drug Administration from December 2007 through May 2008 for various conditions encountered in an internal medicine setting. These new treatments dramatically vary in their targeted body system and include agents for the cardiovascular system (nebivolol), central nervous system (desvenlafaxine), gastrointestinal tract (certolizumab, methylnaltrexone, and alvimopan), immunological function (etravirine), and metabolic function (sapropterin). This article discusses medications by their respective body system. Each review is comprised of an overview of the Food and Drug Administration–approved indication and the drug’s role in treatment of that disease state. Current dosing guidance, clinical efficacy and clinically relevant adverse drug reactions, drug interactions, contraindications, and precautions are also presented. This review is designed to focus on the new molecular entities and biological approvals clinicians may potentially encounter in an internal medicine practice.
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Affiliation(s)
- Debra W. Kemp
- From the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (DWK); and Durham VA Medical Center, Durham (DWK, JNB), North Carolina
| | - Jamie N. Brown
- From the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (DWK); and Durham VA Medical Center, Durham (DWK, JNB), North Carolina
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Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: Data From SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure). J Am Coll Cardiol 2009; 53:2150-8. [PMID: 19497441 DOI: 10.1016/j.jacc.2009.02.046] [Citation(s) in RCA: 374] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 01/27/2009] [Accepted: 02/03/2009] [Indexed: 12/16/2022]
Abstract
OBJECTIVES In this pre-specified subanalysis of the SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure) trial, which examined the effects of nebivolol in elderly heart failure (HF) patients, we explored the effects of left ventricular ejection fraction (EF) on outcomes, including the subgroups impaired EF (< or =35%) and preserved EF (>35%). BACKGROUND Beta-blockers are established drugs in patients with HF and impaired EF, but their value in preserved EF is unclear. METHODS We studied 2,111 patients; 1,359 (64%) had impaired (< or =35%) EF (mean 28.7%) and 752 (36%) had preserved (>35%) EF (mean 49.2%). The effect of nebivolol was investigated in these 2 groups, and it was compared to explore the interaction of EF with outcome. Follow-up was 21 months; the primary end point was all-cause mortality or cardiovascular hospitalizations. RESULTS Patients with preserved EF were more often women (49.9% vs. 29.8%) and had less advanced HF, more hypertension, and fewer prior myocardial infarctions (all p < 0.001). During follow-up, the primary end point occurred in 465 patients (34.2%) with impaired EF and in 235 patients (31.2%) with preserved EF. The effect of nebivolol on the primary end point (hazard ratio [HR] of nebivolol vs. placebo) was 0.86 (95% confidence interval: 0.72 to 1.04) in patients with impaired EF and 0.81 (95% confidence interval: 0.63 to 1.04) in preserved EF (p = 0.720 for subgroup interaction). Effects on all secondary end points were similar between groups (HR for all-cause mortality 0.84 and 0.91, respectively), and no p value for interaction was <0.48. CONCLUSIONS The effect of beta-blockade with nebivolol in elderly patients with HF in this study was similar in those with preserved and impaired EF.
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The anti-inflammatory effects of nebivolol in human coronary smooth muscle cells: Clinical implications. Int J Cardiol 2009; 133:415-6. [DOI: 10.1016/j.ijcard.2007.11.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Revised: 11/19/2007] [Accepted: 11/25/2007] [Indexed: 11/22/2022]
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Prominent cardioprotective effects of third generation beta blocker nebivolol against anthracycline-induced cardiotoxicity using the model of isolated perfused rat heart. Eur J Cancer 2008; 44:334-40. [PMID: 18194856 DOI: 10.1016/j.ejca.2007.12.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 12/10/2007] [Accepted: 12/14/2007] [Indexed: 11/21/2022]
Abstract
Nebivolol is a cardioselective beta-blocker (BB) currently used for the treatment of hypertension. It has mild vasodilating properties attributed to its interaction with the L-arginine/nitric oxide pathway, a property not shared by other BBs. Carvedilol is a nonselective ss-adrenergic receptor antagonist that also blocks alpha1-adrenergic receptors and is a potent antioxidant. Anthracyclines (ANTs), daunorubicin and doxorubicin, are commonly used in the treatment of several tumours, but their cardiac toxicity prevents their use at maximum myelotoxic doses, representing an important problem. In this study, we have evaluated the role of these BBs administered in combination with ANTs (daunorubicin and doxorubicin) on a reduction in cardiac toxicity. The combination of BB and ANTs has reduced the release of GSSG and GSH; in particular, co-treatment with nebivolol to ANTs has shown a significant reduction. The total integrated creatine kinase and troponin T activities were improved by BB and ANTs co-treatment. A significant reduction of their release was observed when hearts were treated with nebivolol. Cardiac tissue activity of gluthatione reductase was not significant and similar among experimental groups. In contrast, gluthatione peroxidise, Mn-superoxide dismutase and nitrite/nitrate release were increased after co-treatment with nebivolol. Finally, three parameters have been used to evaluate the cardiac toxicity of ANTs: the left ventricular pressure developed under a constant perfusion pressure (LVDP), the rate of variation of this parameter during systole (contractility) (LV/dt)max and during diastole (relaxation) (LV(dP/dt)min. Combination with BB has shown a reduction in cardiac toxicity; in particular, nebivolol has exerted the most significant cardioprotective effect.
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