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Abstract
BACKGROUND/PURPOSE To describe a patient with visually symptomatic circumscribed choroidal hemangioma (CCH) treated successfully with intravitreal beta-blocker. METHODS This is an interventional single case report of a 63 year-old man with a juxtafoveal CCH and extensive subretinal fluid (SRF) unsuccessfully treated with intravitreal anti-VEGF. Off-label intravitreal use of metoprolol (50μg/0.05 ml) was then performed. Main outcome measures were resolution or decreased subretinal fluid on OCT, visual stability or improvement, lack of retinal/ocular toxicity. RESULTS Following 2 intravitreal injections of metoprolol (1 month apart), significant response was observed with decrease of SRF and visual improvement to 20/400 during a 9-week follow-up after the injections. CONCLUSION These preliminary findings suggest that intravitreal metoprolol can be a safe alternative treatment for patients with CCH. This off-label therapy could represent another option for patients with this condition.
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Affiliation(s)
- Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Leandro Chaves
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Armando da Silva Cunha
- Faculty of Pharmacy, Minas Gerais Federal University, Belo Horizonte, Minas Gerais, Brazil ; and
| | - Zelia M Correa
- Departments of Ophthalmology and Oncology, Wilmer Eye Institute, Sidney Kimmel Comprehensive Cancer Institute, John Hopkins Medicine, Baltimore, Maryland
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Oduah MTA, Perera ND, Brenes-Salazar JA. 52-Year-Old Woman With Palpitations, Abdominal Distension, and Severe Abdominal Pain. Mayo Clin Proc 2021; 96:2911-2916. [PMID: 34736614 DOI: 10.1016/j.mayocp.2021.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Mary-Tiffany A Oduah
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Nirosha D Perera
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jorge A Brenes-Salazar
- Advisor to residents and Consultant in Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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Clemente-Moragón A, Martínez-Milla J, Oliver E, Santos A, Flandes J, Fernández I, Rodríguez-González L, Serrano Del Castillo C, Ioan AM, López-Álvarez M, Gómez-Talavera S, Galán-Arriola C, Fuster V, Pérez-Calvo C, Ibáñez B. Metoprolol in Critically Ill Patients With COVID-19. J Am Coll Cardiol 2021; 78:1001-1011. [PMID: 34474731 PMCID: PMC8404624 DOI: 10.1016/j.jacc.2021.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Severe coronavirus disease-2019 (COVID-19) can progress to an acute respiratory distress syndrome (ARDS), which involves alveolar infiltration by activated neutrophils. The beta-blocker metoprolol has been shown to ameliorate exacerbated inflammation in the myocardial infarction setting. OBJECTIVES The purpose of this study was to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19-associated ARDS. METHODS A total of 20 COVID-19 patients with ARDS on invasive mechanical ventilation were randomized to metoprolol (15 mg daily for 3 days) or control (no treatment). All patients underwent bronchoalveolar lavage (BAL) before and after metoprolol/control. The safety of metoprolol administration was evaluated by invasive hemodynamic and electrocardiogram monitoring and echocardiography. RESULTS Metoprolol administration was without side effects. At baseline, neutrophil content in BAL did not differ between groups. Conversely, patients randomized to metoprolol had significantly fewer neutrophils in BAL on day 4 (median: 14.3 neutrophils/µl [Q1, Q3: 4.63, 265 neutrophils/µl] vs median: 397 neutrophils/µl [Q1, Q3: 222, 1,346 neutrophils/µl] in the metoprolol and control groups, respectively; P = 0.016). Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation (PaO2:FiO2) significantly improved after 3 days of metoprolol treatment (median: 130 [Q1, Q3: 110, 162] vs median: 267 [Q1, Q3: 199, 298] at baseline and day 4, respectively; P = 0.003), whereas it remained unchanged in control subjects. Metoprolol-treated patients spent fewer days on invasive mechanical ventilation than those in the control group (15.5 ± 7.6 vs 21.9 ± 12.6 days; P = 0.17). CONCLUSIONS In this pilot trial, intravenous metoprolol administration to patients with COVID-19-associated ARDS was safe, reduced exacerbated lung inflammation, and improved oxygenation. Repurposing metoprolol for COVID-19-associated ARDS appears to be a safe and inexpensive strategy that can alleviate the burden of the COVID-19 pandemic.
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Affiliation(s)
| | - Juan Martínez-Milla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Eduardo Oliver
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Arnoldo Santos
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Javier Flandes
- Department of Pulmonary Medicine, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Iker Fernández
- Department of Pulmonary Medicine, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Lorena Rodríguez-González
- Pathology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; Biobank Patform-PT20/00141, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | | | - Ana-María Ioan
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - María López-Álvarez
- Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Sandra Gómez-Talavera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - César Pérez-Calvo
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain.
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Zhang JG, Dai SP, Liu H, Xu ZS. Comparison of carvedilol versus metoprolol in patients with acute myocardial infarction: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25855. [PMID: 34011052 PMCID: PMC8137039 DOI: 10.1097/md.0000000000025855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The existing meta-analyses and randomized studies on comparing the effects of carvedilol and metoprolol are of poor quality, with small sample sizes, and involve a homogeneous population. Therefore, to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to compare the mortality benefits of carvedilol with metoprolol head to head and determine the better beta-blocker in acute myocardial infarction (AMI) setting. METHODS Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library will be searched in May 2021 by 2 independent reviewers. The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. The primary outcome is all-cause mortality; secondary outcomes include complex cardiovascular events, sudden death, cardiovascular death, reinfarction, revascularization, readmission, ventricular arrhythmias, and drug withdrawal for all causes except death. All outcomes are pooled on random-effect model. A P value of <.05 is considered to be statistically significant. RESULTS The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. OSF REGISTRATION NUMBER 10.17605/OSF.IO/VSTJC.
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Vigneswaran TV, Rosenthal E, Bakalis S, Nelson-Piercy C, Chappell L, Simpson JM. Transplacental metoprolol for fetal supraventricular tachycardia. Ultrasound Obstet Gynecol 2020; 56:462-464. [PMID: 31743523 DOI: 10.1002/uog.21924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Affiliation(s)
- T V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - E Rosenthal
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - S Bakalis
- Department of Women's Health, Guy's & St Thomas' Hospital, London, UK
| | - C Nelson-Piercy
- Department of Women's Health, Guy's & St Thomas' Hospital, London, UK
| | - L Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
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Cheng X, Zhu M, Liu Q, Feng Z, Meng Y. <p>Effectiveness of Metoprolol in Improving Cardiac and Motor Functions in Patients with Chronic Heart Failure: A Prospective Study</p>. Drug Des Devel Ther 2020; 14:3485-3494. [PMID: 32921985 PMCID: PMC7457782 DOI: 10.2147/dddt.s263026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- XiaoLiang Cheng
- Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Min Zhu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Qing Liu
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Zhenxia Feng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Yong Meng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
- Correspondence: Yong Meng Email
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Podlesnikar T, Pizarro G, Fernández-Jiménez R, Montero-Cabezas JM, Greif N, Sánchez-González J, Bucciarelli-Ducci C, Marsan NA, Fras Z, Bax JJ, Fuster V, Ibáñez B, Delgado V. Left ventricular functional recovery of infarcted and remote myocardium after ST-segment elevation myocardial infarction (METOCARD-CNIC randomized clinical trial substudy). J Cardiovasc Magn Reson 2020; 22:44. [PMID: 32522198 PMCID: PMC7288440 DOI: 10.1186/s12968-020-00638-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We aimed to evaluate the effect of early intravenous metoprolol treatment, microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and adverse left ventricular (LV) remodeling on the evolution of infarct and remote zone circumferential strain after acute anterior ST-segment elevation myocardial infarction (STEMI) with feature-tracking cardiovascular magnetic resonance (CMR). METHODS A total of 191 patients with acute anterior STEMI enrolled in the METOCARD-CNIC randomized clinical trial were evaluated. LV infarct zone and remote zone circumferential strain were measured with feature-tracking CMR at 1 week and 6 months after STEMI. RESULTS In the overall population, the infarct zone circumferential strain significantly improved from 1 week to 6 months after STEMI (- 8.6 ± 9.0% to - 14.5 ± 8.0%; P < 0.001), while no changes in the remote zone strain were observed (- 19.5 ± 5.9% to - 19.2 ± 3.9%; P = 0.466). Patients who received early intravenous metoprolol had significantly more preserved infarct zone circumferential strain compared to the controls at 1 week (P = 0.038) and at 6 months (P = 0.033) after STEMI, while no differences in remote zone strain were observed. The infarct zone circumferential strain was significantly impaired in patients with MVO and IMH compared to those without (P < 0.001 at 1 week and 6 months), however it improved between both time points regardless of the presence of MVO or IMH (P < 0.001). In patients who developed adverse LV remodeling (defined as ≥ 20% increase in LV end-diastolic volume) remote zone circumferential strain worsened between 1 week and 6 months after STEMI (P = 0.036), while in the absence of adverse LV remodeling no significant changes in remote zone strain were observed. CONCLUSIONS Regional LV circumferential strain with feature-tracking CMR allowed comprehensive evaluation of the sequelae of an acute STEMI treated with primary percutaneous coronary intervention and demonstrated long-lasting cardioprotective effects of early intravenous metoprolol. TRIAL REGISTRATION ClinicalTrials.gov, NCT01311700. Registered 8 March 2011 - Retrospectively registered.
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Affiliation(s)
- Tomaž Podlesnikar
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
- Internal Medicine Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Ruber Juan Bravo Hospital Universidad Europea, Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jose M Montero-Cabezas
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Nina Greif
- Faculty of Medicine University of Maribor, Maribor, Slovenia
| | | | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Zlatko Fras
- Internal Medicine Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
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Thibault N, Ibrahim J, Peterschmitt MJ, Puga AC, Ross L, Vu L, Xue Y, Turpault S. Effect of eliglustat on the pharmacokinetics of digoxin, metoprolol, and oral contraceptives and absorption of eliglustat when coadministered with acid-reducing agents. Mol Genet Metab 2020; 129:278-285. [PMID: 32029355 DOI: 10.1016/j.ymgme.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/25/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
Eliglustat is an oral substrate reduction therapy indicated for patients with Gaucher disease type 1. Based on in vitro data, clinical trials were conducted to assess the potential for drug-drug interactions between eliglustat and digoxin (P-glycoprotein substrate), metoprolol (sensitive CYP2D6 substrate), a combined oral contraceptive (CYP3A substrate), and acid-reducing agents. Healthy subjects were enrolled in four Phase 1 clinical studies to evaluate the effect of eliglustat on the pharmacokinetics, safety, and tolerability of digoxin (N = 28), metoprolol (N = 14), and a combined oral contraceptive (N = 30) and the effect of acid-reducing agents on eliglustat pharmacokinetics, safety, and tolerability (N = 24). Coadministration resulted in increased exposure to digoxin (1.49-fold) and metoprolol (2-fold) with eliglustat, negligible effects on oral contraceptive pharmacokinetics with eliglustat, and a negligible effect of acid-reducing agents on eliglustat pharmacokinetics. Across all studies, eliglustat was well-tolerated. One serious adverse event (spontaneous abortion) and one discontinuation due to an adverse event (urinary tract infection) were reported, both during the acid-reducing agents study. When eliglustat is coadministered with medications that are P-glycoprotein or CYP2D6 substrates, lower doses of these concomitant medications may be required. Eliglustat may be coadministered with oral contraceptives and acid-reducing agents without dose modifications for either drug.
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Affiliation(s)
| | | | | | | | | | - Lucie Vu
- Sanofi Genzyme, Cambridge, MA, USA
| | - Yong Xue
- Sanofi Genzyme, Cambridge, MA, USA
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Li D, Dong W, Liu Y, Wang J, Mu Y, Zhou H, Wang J, Zhou S, Chen Y. Impact of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: protocol for a multicentre prospective study. BMJ Open 2019; 9:e031972. [PMID: 31806613 PMCID: PMC6924777 DOI: 10.1136/bmjopen-2019-031972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Metoprolol is the most frequently used β-receptor blockers; however, the prescribed dose in China is far less than the recommended doses in the guidelines. Based on the Chinese and International guidelines and the Chinese clinical practice, we are conducting this study (NCT03413410) to test the feasibility and tolerability of the metoprolol optimal dosing pathway by observing the percentage of patients achieving target dose in Chinese acute coronary syndrome (ACS) patients during hospitalisation. METHODS AND ANALYSIS A total of about 1000 patients aged ≥18 years, hospitalised for ACS will be enrolled from ~15 hospital sites in China between February 2018 and April 2019. The percentage of patients achieving the target metoprolol dosage at discharge is the primary endpoint. The secondary endpoints included the following: mean heart rate (HR) and blood pressure (BP) of the patients who have achieved target dose at discharge and during the follow-up period, percentage of patients experiencing bradycardia (HR <50 beats/min), hypotension (BP <90/60 mm Hg) and drug-related temporary heart failure worsening during hospitalisation and 1 month after discharge, respectively. We will also assess the proportion of patients reporting metoprolol-related adverse events and the leading causes for metoprolol discontinuation. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics committee of the Chinese PLA General Hospital (number: S2017-112-01). Study findings will be disseminated through presentations at national and international conferences and submitted for publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry (NCT03413410).
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Affiliation(s)
- Dandan Li
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Wei Dong
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yuqi Liu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jingjing Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yang Mu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hao Zhou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jing Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Shanshan Zhou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
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Ågesen FN, Weeke PE, Tfelt‐Hansen P, Tfelt‐Hansen J. Pharmacokinetic variability of beta-adrenergic blocking agents used in cardiology. Pharmacol Res Perspect 2019; 7:e00496. [PMID: 31338197 PMCID: PMC6624454 DOI: 10.1002/prp2.496] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/25/2019] [Accepted: 05/22/2019] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to evaluate the pharmacokinetic variability of beta-adrenergic blocking agents used in cardiology by reviewing single-dose and steady-state pharmacokinetic studies from the literature. PubMed was searched for pharmacokinetic studies of beta-adrenergic blocking agents, both single-dose and steady-state studies. The studies included reported maximum plasma concentration (Cmax) and/or area under the concentration curve (AUC). The coefficient of variation (CV%) was calculated for all studies, and a CV% <40% was considered low or moderate variability, and a CV% >40% was considered high variability. The Cmax and AUC were reported a total of 672 times in 192 papers. Based on AUC, metoprolol, propranolol, carvedilol, and nebivolol showed high pharmacokinetic variability (highest first), whereas bisoprolol, atenolol, sotalol, labetalol, nadolol, and pindolol showed low to moderate variability (lowest first). We have shown a high interindividual pharmacokinetic variability that varies markedly in different beta-adrenergic blocking agents; the extreme being steady state ratios as high as 30 in metoprolol. A more personalized approach to the medical treatment of patients may be obtained by combining known pharmacokinetic information about variability, pharmaco-genetics and -dynamics, and patient characteristics, to avoid adverse events or lack of treatment effect.
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Affiliation(s)
- Frederik N. Ågesen
- Department of CardiologyUniversity of CopenhagenRigshospitalet, CopenhagenDenmark
| | - Peter E. Weeke
- Department of CardiologyUniversity of CopenhagenRigshospitalet, CopenhagenDenmark
| | - Peer Tfelt‐Hansen
- Danish Headache Center, Department of NeurologyUniversity of Copenhagen, Rigshospitalet‐Glostrup HospitalGlostrupDenmark
| | - Jacob Tfelt‐Hansen
- Department of CardiologyUniversity of CopenhagenRigshospitalet, CopenhagenDenmark
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Liu M, Liu J, Zhang L, Geng Q, Ge Y. Antidepressant-like effects of ginseng fruit saponin in myocardial infarction mice. Biomed Pharmacother 2019; 115:108900. [PMID: 31054510 DOI: 10.1016/j.biopha.2019.108900] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Recently, the development of cardiovascular disease (CVD) has been proved to be closely associated with depression in which 5-HT plays a crucial role. Ginseng Fruit Saponin (GFS) and Metoprolol are two drugs which have beneficial effects on the cardiovascular system in Myocardial Infarction (MI) mice. However, their effects on depression-like behaviors after MI and its underlying mechanisms remain unknown. We aimed to investigate their antidepressive-like effects as well as their impacts on the 5-HT system. METHODS The MI model was established by ligating left anterior descending coronary artery. Mice were administered with GFS, Metoprolol or saline for 4 weeks. Cardiac function was evaluated and depressive-like behaviors were quantified at the end of the experiments. Masson's staining was used to assess myocardial fibrosis while immunohistochemistry, western blot, ELISA and qPCR were performed to analyze the levels of 5-HT and its related genes. RESULTS Compared with MI groups, Both GFS and Metoprolol treatments significantly improved cardiac function and reduced myocardial fibrosis. Moreover, GFS but not Metoprolol increased the levels of 5-HT in the cortex and rescued depression-like behaviors in MI mice. CONCLUSIONS GFS has potential antidepressive effects and the mechanisms involve the regulation of 5-HT concentrations in the cortex.
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Affiliation(s)
- Meiyan Liu
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, China.
| | - Jianyang Liu
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, China
| | - Lijun Zhang
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong General Hospital, Guangdong, 510080, China
| | - Yingbin Ge
- Department of Physiology, Nanjing Medical University, Jiangsu, 211166, China.
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Abstract
Although orthostatic hypotension (OH) is often considered a contraindication to blood pressure (BP) treatment, evidence is lacking. We examined the effect of BP goal or initial medication choice on OH in AASK (African American Study of Kidney Disease and Hypertension), a 2×3 factorial trial. Blacks with chronic kidney disease attributed to hypertension were randomly assigned 1 of 2 BP goals: intensive (mean arterial pressure, ≤92 mm Hg) or standard (mean arterial pressure, 102-107 mm Hg) and 1 of 3 initial medications (ramipril, metoprolol, and amlodipine). Postural changes in systolic BP, diastolic BP, or heart rate (HR) were determined after 2 minutes and 45 seconds of standing. OH was assessed each visit and defined using the consensus definition (drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg). Median follow-up was 4 years. Outcomes were congestive heart failure, stroke, nonfatal cardiovascular disease (CVD), fatal CVD, any CVD (composite of preceding events), and all-cause mortality. There were 1094 participants (mean age, 54.5±10.7 years; 38.8% female; OH was assessed at 52 864 visits). Mean seated systolic BP, diastolic BP, and HR were 150.3±23.9 mm Hg, 95.5±14.2 mm Hg, and 72.0±12.6 bpm, respectively. A more intensive BP goal did not alter the distributions of standing BP and was not associated with OH, but metoprolol was associated with systolic OH compared with ramipril (odds ratio, 1.68; 95% CI, 1.15-2.46) and amlodipine (odds ratio, 1.94; 95% CI, 1.09-3.44). Although consensus OH was associated with stroke (HR, 5.01; 95% CI, 1.80-13.92), nonfatal CVD (HR, 2.28; 95% CI, 1.21-4.30), and any CVD event (HR, 2.12; 95% CI, 1.12-3.98), neither BP goal or medication altered this risk. Concerns about causing OH or its CVD consequences should not deter a lower BP goal among adults with chronic kidney disease attributed to hypertension.
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Affiliation(s)
- Stephen P Juraschek
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J., K.J.M., L.A.L.)
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD (S.P.J., L.J.A., E.R.M.)
| | - Lawrence J Appel
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J., K.J.M., L.A.L.)
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD (S.P.J., L.J.A., E.R.M.)
| | - Edgar R Miller
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD (S.P.J., L.J.A., E.R.M.)
| | - Kenneth J Mukamal
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J., K.J.M., L.A.L.)
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Jiang W, Chen C, Huo J, Lu D, Jiang Z, Geng J, Xu H, Shan Q. Comparison between renal denervation and metoprolol on the susceptibility of ventricular arrhythmias in rats with myocardial infarction. Sci Rep 2018; 8:10206. [PMID: 29976952 PMCID: PMC6033884 DOI: 10.1038/s41598-018-28562-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/25/2018] [Indexed: 12/13/2022] Open
Abstract
Ventricular arrhythmias (VAs) are the leading cause of sudden cardiac death in patients with myocardial infarction (MI). We sought to compare effects of renal denervation (RDN) and metoprolol on VAs after MI. Fifty-four male Sprague-Dawley rats underwent ligation of left anterior descending coronary artery to induce MI, while 6 rats served as Control. Metoprolol was given 20 mg/kg/day for 5 weeks after MI surgery. RDN/Sham-RDN procedure was performed at 1 week after MI. At 5 weeks after MI, electrical programmed stimulation (EPS) was performed in all groups for evaluation of VAs. After EPS, heart and kidneys were harvested. Compared with MI group, RDN and metoprolol significantly decreased the incidence of VAs, and RDN is superior to metoprolol. Compared with metoprolol group, Masson staining showed that RDN significantly reduced the myocardial fibrosis. Both RDN and metoprolol decreased the protein expression of connexin43 (Cx43) compared with MI group, while only RDN lighted this decrease remarkably. Immunohistochemical staining of Tyrosine hydroxylase (TH) and growth associated protein 43 (GAP43) revealed that RDN and metoprolol had similar effect on reducing densities of sympathetic nerve in infarction border zone. According to this study, RDN is more effective in reducing VAs than metoprolol in ischemic cardiomyopathy model.
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Affiliation(s)
- Wanying Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Chu Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Junyu Huo
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Dasheng Lu
- Department of Cardiology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jie Geng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hai Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qijun Shan
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Fowler ED, Drinkhill MJ, Norman R, Pervolaraki E, Stones R, Steer E, Benoist D, Steele DS, Calaghan SC, White E. Beta1-adrenoceptor antagonist, metoprolol attenuates cardiac myocyte Ca 2+ handling dysfunction in rats with pulmonary artery hypertension. J Mol Cell Cardiol 2018; 120:74-83. [PMID: 29807024 PMCID: PMC6013283 DOI: 10.1016/j.yjmcc.2018.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 01/13/2023]
Abstract
Right heart failure is the major cause of death in Pulmonary Artery Hypertension (PAH) patients but is not a current, specific therapeutic target. Pre-clinical studies have shown that adrenoceptor blockade can improve cardiac function but the mechanisms of action within right ventricular (RV) myocytes are unknown. We tested whether the β1-adrenoceptor blocker metoprolol could improve RV myocyte function in an animal model of PAH, by attenuating adverse excitation-contraction coupling remodeling. PAH with RV failure was induced in rats by monocrotaline injection. When PAH was established, animals were given 10 mg/kg/day metoprolol (MCT + BB) or vehicle (MCT). The median time to the onset of heart failure signs was delayed from 23 days (MCT), to 31 days (MCT + BB). At 23 ± 1 days post-injection, MCT + BB showed improved in vivo cardiac function, measured by echocardiography. RV hypertrophy was reduced despite persistent elevated afterload. RV myocyte contractility during field stimulation was improved at higher pacing frequencies in MCT + BB. Preserved t-tubule structure, more uniform evoked Ca2+ release, increased SERCA2a expression and faster ventricular repolarization (measured in vivo by telemetry) may account for the improved contractile function. Sarcoplasmic reticulum Ca2+ overload was prevented in MCT + BB myocytes resulting in fewer spontaneous Ca2+ waves, with a lower pro-arrhythmic potential. Our novel finding of attenuation of defects in excitation contraction coupling by β1-adrenoceptor blockade with delays in the onset of HF, identifies the RV as a promising therapeutic target in PAH. Moreover, our data suggest existing therapies for left ventricular failure may also be beneficial in PAH induced RV failure.
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Affiliation(s)
- Ewan D Fowler
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK; School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK
| | - Mark J Drinkhill
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Ruth Norman
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | | | - Rachel Stones
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Emma Steer
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - David Benoist
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK; L'institut de rythmologie et modélisation cardiaque, Inserm U-1045, Université de Bordeaux, Bordeaux, France
| | - Derek S Steele
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Sarah C Calaghan
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Ed White
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
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Duan H, Lu Y, Yan S, Qiao L, Hua Y, Li Y, Zhou K, Wang C. A delayed diagnosis of catecholaminergic polymorphic ventricular tachycardia with a mutant of RYR2 at c.7580T>G for 6 years in a 9-year-old child. Medicine (Baltimore) 2018; 97:e0368. [PMID: 29668588 PMCID: PMC5916663 DOI: 10.1097/md.0000000000010368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare but potentially lethal inherited arrhythmia syndrome induced by adrenergic stress. Due to the atypical clinical manifestations in early age, limited recognition and experience of pediatric cardiologists, and low awareness of the significance of genetic diagnosis in some underdeveloped areas in China, a delayed or missed diagnosis of CPVT in children is common and concerning. PATIENT CONCERNS A 9-year and 3-month male child with recurrent exercise-induced syncope accompanied by convulsion was initially misdiagnosed as epilepsy since the first manifestation at the age of 3 years. Due to the identification of polymorphic ventricular premature beats, nonsustained ventricular tachycardia (VT), and supraventricular tachycardia, a cardiogenic etiology was established. The patient received a successive treatment by propafenone, amiodarone, a combination of amiodarone with metoprolol, and metoprolol alone for up to 6 years. DIAGNOSES Given the poor response to conventional antiarrhythmics, excise-induced syncope, QRS morphology and a structurally normal heart, the diagnosis of CPVT was suspected, and ultimately confirmed by detection of polymorphic and bidirectional VT with degeneration into ventricular fibrillation during exercise testing. In addition, a heterozygous mutant of RYR2 at c.7580T > G was identified by genetic testing. INTERVENTIONS Due to the unavailability of flecainide in China and the refusal of implantable cardioverter defibrillator implantation by his parents, this patient continued to be treated with oral metoprolol. OUTCOMES Unfortunately, the effect was unfavorable during 4 months outpatient follow-up. LESSONS CPVT should be suspected in young patients with a normal baseline electrocardiogram (EKG), a structurally normal heart and polymorphic and/or bidirectional ventricular tachycardia induced by exercise or emotional stress. Exercise and genetic testing is essential and significant for a timely and accurate diagnosis of CPVT. The current study firstly reported a case with CPVT associated with a mutant of RYR2 at c.7580T > G in children.
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Affiliation(s)
- Hongyu Duan
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
| | - Yongyi Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Song Yan
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lina Qiao
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
| | - Kaiyu Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University
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16
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Hansen T, Fynne L. [Jaundice and liver injury with cholestatic pattern after treatment with Metoprololsuccinat]. Ugeskr Laeger 2017; 179:V09170698. [PMID: 29260695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Drug-induced liver injury is a well-known adverse event to numerous medications with clinical presentations from asymptomatic liver enzyme elevation to liver failure. However, liver injury after administration with metoprolol is not common, and only few case reports have been published. This is a case report of an 80-year-old woman with liver injury with cholestatic pattern and jaundice after two months of treatment with Metoprololsuccinat. With no evidence of other disease, liver function normalized in the following months after discontinuation of Metoprololsuccinat.
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17
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Saqan R, Thiabat H. Evaluation of the safety and efficacy of metoprolol infusion for children and adolescents with hypertensive crises: a retrospective case series. Pediatr Nephrol 2017; 32:2107-2113. [PMID: 28733751 DOI: 10.1007/s00467-017-3720-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute severe hypertension occurs infrequently in pediatric patients and, consequently, data on the efficacy and safety of most antihypertensive agents, as well as the adverse events associated with these agents, are very limited in this population. In this case series, we evaluated the use of metoprolol infusion in children with hypertensive emergencies. METHODS The study population comprised children younger than 18 years who had been admitted to the pediatric intensive care unit at King Abdullah University Hospital with blood pressure above the 99th percentile for age, height, and sex and who were symptomatic at the time of presentation. Metoprolol was given as an infusion at a dose of 1-5 mcg/kg/min. The rate of decrease in blood pressure, side effects from the medication, and outcome were assessed. RESULTS Thirteen patients ranging in age from 2 months to 16 years were included in this study. The initial mean blood pressure was 23-75 mmHg above the 99th percentile for age, height, and sex. Metoprolol was initiated at a dose of 0.5 mcg/kg/min and titrated according to the target blood pressure to a maximum of 5 mcg/kg/min. Mean blood pressure fell by an average of 12.3, 20.4, and 27.1% at 1, 8, and 24 h, respectively, which is consistent with findings on the use of other intravenous medications reported in published studies. The heart rate did not decrease below the normal range for age. There were no significant side effects of the metoprolol infusion. All patients were discharged home with no neurological sequelae secondary to their hypertension. CONCLUSION An infusion of metoprolol for a hypertensive emergency is a safe and effective treatment for pediatric patients.
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Affiliation(s)
- Rola Saqan
- Jordan University of Science and Technology, Irbid, Irbid, Jordan.
| | - Hanan Thiabat
- Jordan University of Science and Technology, Irbid, Irbid, Jordan
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18
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Siniatchkin M, Andrasik F, Kropp P, Niederberger U, Strenge H, Averkina N, Lindner V, Stephani U, Gerber WD. Central Mechanisms of Controlled-Release Metoprolol in Migraine: A Double-Blind, Placebo-Controlled Study. Cephalalgia 2016; 27:1024-32. [PMID: 17680819 DOI: 10.1111/j.1468-2982.2007.01377.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
β-Blockers are widely used in the prophylaxis of migraine and have been described as very effective drugs in many studies. Some investigators have demonstrated that the clinical improvement of migraine corresponds to the normalization of the contingent negative variation (CNV), a slow cortical potential measuring cortical information processing. However, most of these studies have contained a variety of methodological pitfalls, which we attempted to address in the current study. Twenty patients suffering from migraine without aura were randomly divided into two groups. The groups were treated either with controlled-release metoprolol or placebo for 3 months, using a double-blind design. Twice before and once after each month of the treatment the CNV was recorded. After 3 months, a significant reduction of migraine frequency, duration and intensity was demonstrated for the metoprolol compared with the placebo group. The CNV was characterized by a marked reduction of the amplitude of the total CNV and postimperative negative variation and normalization of the eartly CNV habituation following treatment. Therefore, metoprolol may exert its prophylactic effect in migraine through the influence on cortical information processing and excitability represented by the CNV.
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Affiliation(s)
- M Siniatchkin
- Neuropaediatric Department, Christian-Albrechts-University of Kiel, Kiel, Germany.
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19
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Wonnacott D, Berringer R. Spontaneous coronary artery dissection: Case report and review of the literature. Can Fam Physician 2016; 62:994-996. [PMID: 27965334 PMCID: PMC5154649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- David Wonnacott
- Second-year resident in the Department of Family Medicine at Queen's University in Kingston, Ont.
| | - Ross Berringer
- Clinical Associate Professor at the University of British Columbia in Vancouver and Clinical Assistant Professor at the University of Ottawa in Ontario
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20
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Athukuri BL, Neerati P. Enhanced oral bioavailability of metoprolol with gallic acid and ellagic acid in male Wistar rats: involvement of CYP2D6 inhibition. Drug Metab Pers Ther 2016; 31:229-234. [PMID: 27875319 DOI: 10.1515/dmpt-2016-0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Cytochrome P450-2D6 (CYP2D6), a member of the CYP450 mixed function oxidase system, is an important CYP isoform with regard to herbal-drug interactions and is responsible for the metabolism of nearly 25% of drugs. Until now, studies on the effects of various phytochemicals on CYP2D6 activity in vivo have been very rare. Gallic acid and ellagic acid are natural polyphenols which are widely distributed in fruits and medicinal plants. In the present study, the effects of gallic acid and ellagic acid pretreatment on intestinal transport and oral bioavailability of metoprolol were investigated. METHODS The intestinal transport of metoprolol was assessed by conducting an in situ single pass intestinal perfusion (SPIP) study. The bioavailability study was conducted to evaluate the pharmacokinetic parameters of orally administered metoprolol in rats. RESULTS After pretreatment with gallic acid and ellagic acid, no significant change in effective permeability of metoprolol was observed at the ileum part of rat intestine. A significant improvement in the peak plasma concentration (Cmax) and area under the serum concentration-time profile (AUC) and decrease in clearance were observed in rats pretreated with gallic acid and ellagic acid. CONCLUSIONS Gallic acid and ellagic acid significantly enhanced the oral bioavailability of metoprolol by inhibiting CYP2D6-mediated metabolism in the rat liver. Hence, adverse herbal-drug interactions may result with concomitant ingestion of gallic acid and ellagic acid supplements and drugs that are CYP2D6 substrates. The clinical assessment of these interactions should be further investigated in human volunteers.
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Yaqoob A, Ahmad M, Mahmood A, Sarfraz RM. PREPARATION, IN VITRO AND IN VIVO CHARACTERIZATION OF HYDROPHOBIC PATCHES OF A HIGHLY WATER SOLUBLE DRUG FOR PROLONGED PLASMA HALF LIFE: EFFECT OF PERMEATION ENHANCERS. Acta Pol Pharm 2016; 73:1639-1648. [PMID: 29634120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aim of present study was to develop metoprolol matrix patches using different enhancers. Combination of two hydrophobic polymers, ethyl cellulose and eudragit RL 100 (8 : 2) were used for preparation of unilaminated matrix patch. 10% w/w of isopropyl myristate (IPM), dimethyl sulfoxide (DMSO), span (20 (S20), Tween 20 (T20) and eucalyptus oil as enhancers and 40% of dibutyl phthalate as plasticizer were used. Prepared patches were evaluated for physical appearance, weight uniformity and thickness. FTIR studies were performed to assess compatibility among ingredients and developed formulation. Dissolution and permeation studies were performed to compare effects of enhancers. Surface morphology after release was examined by scanning electron microscopy. Selected formulation was subjected to in vivo studies by randomized crossover design in rabbits (n = 6) for pharmacokinetic comparison with oral solution administration. Physical evaluation revealed that translucent, flexible, non brittle patches of uniform weight and thickness were prepared. Release from patches followed Higuchi model. Mechanism of release was Fickian. Formulation containing IPM showed that release was by anomalous transport. Highest permeation flux was observed for formulation containing IPM with 2-fold enhancement in permeation. Permeation flux for patches was in order of formulation with no enhancer > IPM > T20 > S20 > DMSO = eucalyptus oil. Plasma concentration from in vivo studies exhibited sustained plasma levels of metoprolol after transdermal patch application in comparison to oral solution administration. Pharmacokinetic analysis of in vivo data elucidated that half life was increased 8 times when compared to oral administration, due to controlled release of drug for longer period of time. These findings suggested that hydrophobic transdermal patches of highly water soluble drug metoprolol were successfully prepared with 10% of IPM for sustained systemic delivery for prolonged half life.
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Zayac A, Shah R, Shah M, Umar J, Bansal N, Dhamoon A. Thyrotoxic hypokalemic periodic paralysis. QJM 2016; 109:613-4. [PMID: 27318366 DOI: 10.1093/qjmed/hcw091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Zayac
- From the SUNY Upstate Medical University, Endocrinology, Syracuse, NY 13210 USA
| | - R Shah
- Syracuse VA Medical Center, Internal Medicine, Syracuse, NY 13210, USA
| | - M Shah
- 50 Presidential Plaza, Syracuse, NY 13210, USA
| | - J Umar
- From the SUNY Upstate Medical University, Endocrinology, Syracuse, NY 13210 USA
| | - N Bansal
- From the SUNY Upstate Medical University, Endocrinology, Syracuse, NY 13210 USA
| | - A Dhamoon
- From the SUNY Upstate Medical University, Endocrinology, Syracuse, NY 13210 USA
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23
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Abstract
The aim of the present work was to prepare and evaluate sublingual fast dissolving films containing metoprolol tartrate-loaded niosomes. Niosomes were utilized to allow for prolonged release of the drug, whereas the films were used to increase the drug's bioavailability via the sublingual route. Niosomes were prepared using span 60 and cholesterol at different drug to surfactant ratios. The niosomes were characterized for size, zeta-potential, and entrapment efficiency. The selected niosomal formulation was incorporated into polymeric films using hydroxypropyl methyl cellulose E15 and methyl cellulose as film-forming polymers and Avicel as superdisintegrant. The physical characteristics (appearance, texture, pH, uniformity of weight and thickness, disintegration time, and palatability) of the prepared films were studied, in addition to evaluating the in vitro drug release, stability, and in vivo pharmacokinetics in rabbits. The release of the drug from the medicated film was fast (99.9% of the drug was released within 30 minutes), while the drug loaded into the niosomes, either incorporated into the film or not, showed only 22.85% drug release within the same time. The selected sublingual film showed significantly higher rate of drug absorption and higher drug plasma levels compared with that of commercial oral tablet. The plasma levels remained detectable for 24 hours following sublingual administration, compared with only 12 hours after administration of the oral tablet. In addition, the absolute bioavailability of the drug (ie, relative to intravenous administration) following sublingual administration was found to be significantly higher (91.06%±13.28%), as compared with that after oral tablet administration (39.37%±11.4%). These results indicate that the fast dissolving niosomal film could be a promising delivery system to enhance the bioavailability and prolong the therapeutic effect of metoprolol tartrate.
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Affiliation(s)
- Ayat Allam
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Gihan Fetih
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt
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Zhu BQ, Simonis U, Cecchini G, Zhou HZ, Li L, Teerlink JR, Karliner JS. Comparison of Pyrroloquinoline Quinone and/or Metoprolol on Myocardial Infarct Size and Mitochondrial Damage in a Rat Model of Ischemia/Reperfusion Injury. J Cardiovasc Pharmacol Ther 2016; 11:119-28. [PMID: 16891289 DOI: 10.1177/1074248406288757] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The cardioprotective effectiveness of low-dose pyrroloquinoline quinone (PQQ, 3 mg/kg) was compared with metoprolol, a β1-selective adrenoceptor antagonist. Rats underwent 30 minutes of left anterior descending coronary artery occlusion and 2 hours of reperfusion. Metoprolol and/or PQQ were given at the onset of reperfusion to mimic clinical treatment. Metoprolol and/or PQQ reduced infarct size and protected against ischemia-induced left ventricular dysfunction after 2 hours of reper-fusion. Combined therapy augmented left ventricular developed pressure at the end of reperfusion. Metoprolol or PQQ alone enhanced mitochondrial respiratory ratios in ischemic and nonischemic myocardium. Although the PQQ/metoprolol combination therapy increased respiratory ratio values, the effects were small when compared with PQQ alone. Only PQQ decreased lipid peroxidation. Metoprolol and/or PQQ given at the onset of reperfusion reduce infarct size and improve cardiac function. Combination therapy further reduces infarct size. PQQ is superior to metoprolol in protecting mitochondria from ischemia/reperfusion oxidative damage
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Affiliation(s)
- Bo-qing Zhu
- Cardiology Section, VA Medical Center, Department of Medicine, University of California-San Francisco, 4150 Clement Street, San Francisco, CA 94121, USA
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Abstract
Heart failure is a growing public health problem in the United States, and the approach to the treatment of heart failure has undergone a radical transformation in the past decade. The use of β-blocker therapy in heart failure patients is now widely recommended, based on evidence from large-scale clinical trials demonstrating that bisoprolol, carvedilol, and extended-release metoprolol succinate significantly reduce morbidity and mortality in patients with heart failure. Although these agents appear to provide similar benefits, the question remains whether pharmacologic differences among them could translate to differences in clinical outcomes. The Carvedilol Or Metoprolol European Trial (COMET) compared nonselective blockade of the β1-/β2-/α1-adrenergic receptors with carvedilol versus selective β1-blockade with immediate-release metoprolol tartrate in patients with chronic heart failure. The trial found that carvedilol significantly reduced all-cause mortality compared with immediate-release metoprolol tartrate, although there were no differences in hospitalizations. Herein we review the pharmacokinetics and pharmacodynamics of metoprolol and carvedilol. In doing so, several issues regarding the design of COMET are identified that could alter the interpretation of the results of this trial. These include the choice of dose and dosage regimen of immediate-release metoprolol tartrate, a dosage form that has never been shown to reduce mortality in patients with heart failure. Additional studies are needed to fully understand whether there are any advantages of selective versus nonselective adrenergic blockade and whether there are any clinically meaningful differences in effectiveness between β-blockers with proven benefit in the management of chronic heart failure. The results of COMET demonstrate that all β-blockers and dosage forms are not interchangeable when prescribed for heart failure. Clinicians should choose only those agents (and dosage forms) that have been proven to reduce mortality in this patient population.
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Affiliation(s)
- Jerry L Bauman
- Departments of Pharmacy Practice and Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
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[Increased physical capacity]. MMW Fortschr Med 2016; 158:65. [PMID: 27333622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Husain T, Shoaib MH, Yousuf RI, Maboos M, Khan M, Bashir L, Naz S. Formulation development and comparative in vitro study of metoprolol tartrate (IR) tablets. Pak J Pharm Sci 2016; 29:853-860. [PMID: 27166530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of the present work was to develop Immediate Release (IR) tablets of Metoprolol Tartrate (MT) and to compare trial formulations to a reference product. Six formulations (F1-F6) were designed using central composite method and compared to a reference brand (A). Two marketed products (brands B and C) were also evaluated. F1-F6 were prepared with Avicel PH101 (filler), Crospovidone (disintegrant) and Magnesium Stearate (lubricant) by direct compression. Pharmacopoeial and non-pharmacopoeial methods were used to assess their quality. Furthermore, drug profiles were characterized using model dependent and independent (f(2)) approaches. Brands B and C and F5 and F6 did not qualify the tests for content uniformity. Moreover, brand B did not meet weight variation criteria and brand C did not satisfy requirements for single point dissolution test. Of the trial formulations, F2 failed the test for uniformity in thickness while F4 did not disintegrate within time limit. Only F1 and F3 met all quality parameters and were subjected to accelerated stability testing without significant alterations in their physicochemical characteristics. Based on AIC and r(2)(adjusted) values obtained by applying various kinetic models, drug release was determined to most closely follow Hixson-Crowell cube root law. F1 was determined to be the optimized formulation.
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Affiliation(s)
- Tazeen Husain
- Department of Pharmaceutics, Faculty of Pharmacy & Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Muhammad Harris Shoaib
- Department of Pharmaceutics, Faculty of Pharmacy & Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Rabia Ismail Yousuf
- Department of Pharmaceutics, Faculty of Pharmacy & Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Madiha Maboos
- Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan
| | - Madeeha Khan
- Faculty of Pharmacy, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Lubna Bashir
- Department of Pharmaceutics, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Shazia Naz
- Department of Pharmaceutics, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
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[Anti-angina fixed combination is available]. MMW Fortschr Med 2016; 158:89. [PMID: 27228585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Raj SR, Faris PD, Semeniuk L, Manns B, Krahn AD, Morillo CA, Benditt DG, Sheldon RS. Rationale for the Assessment of Metoprolol in the Prevention of Vasovagal Syncope in Aging Subjects Trial (POST5). Am Heart J 2016; 174:89-94. [PMID: 26995374 DOI: 10.1016/j.ahj.2016.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vasovagal syncope (VVS) is a common problem associated with a poor quality of life, which improves when syncope frequency is reduced. Effective pharmacological therapies for VVS are lacking. Metoprolol is a β-adrenergic receptor antagonist that is ineffective in younger patients, but may benefit older (≥40 years) VVS patients. Given the limited therapeutic options, a placebo-controlled clinical trial of metoprolol for the prevention of VVS in older patients is needed. STRUCTURE OF STUDY The POST5 is a multicenter, international, randomized, placebo-controlled study of metoprolol in the prevention of VVS in patients ≥40 years old. The primary endpoint is the time to first recurrence of syncope. Patients will be randomized 1:1 to receive metoprolol 25 to 100 mg BID or matching placebo, and followed up for 1 year. Secondary end points include syncope frequency, presyncope, quality of life, and cost analysis. Primary analysis will be intention to treat, with a secondary on-treatment analysis. POWER CALCULATIONS A sample size of 222, split equally between the groups achieves 85% power to detect a hazard rate of 0.3561 when the event rates are 50% and 30% in the placebo and metoprolol arms. Allowing for 10% dropout, we propose to enroll 248 patients. IMPLICATIONS This study will be the first adequately powered trial to determine whether metoprolol is effective in preventing VVS in patients ≥40 years. If effective, metoprolol may become the first line pharmacological therapy for these patients.
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Affiliation(s)
- Satish R Raj
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada; Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, TN.
| | | | - Lisa Semeniuk
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Braden Manns
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | - David G Benditt
- Cardiac Arrhythmia and Syncope Center, University of Minnesota, Minneapolis, MN
| | - Robert S Sheldon
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
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Ijaz H, Qureshi J, Danish Z, Zaman M, Abdel-Daim M, Hanif M, Waheed I, Mohammad IS. Formulation and in-vitro evaluation of floating bilayer tablet of lisinopril maleate and metoprolol tartrate. Pak J Pharm Sci 2015; 28:2019-2025. [PMID: 26639495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to introduce the technology for the development of rate-controlled oral drug delivery system to overcome various physiological problems. Several approaches are being used for the purpose of increasing the gastric retentive time, including floating drug delivery system. Gastric floating lisinopril maleate and metoprolol tartrate bilayer tablets were formulated by direct compression method using the sodium starch glycolate, crosscarmellose sodium for IR layer. Eudragit L100, pectin, acacia as sustained release polymers in different ratios for SR metoprolol tartrate layer and sodium bicarbonate, citric acid as gas generating agents for the floating extended release layer. The floating bilayer tablets of lisinopril maleate and metoprolol tartrate were designed to overcome the various problems associated with conventional oral dosage form. Floating tablets were evaluated for floating lag time, drug contents and in-vitro dissolution profile and different kinetic release models were applied. It was clear that the different ratios of polymers affected the drug release and floating time. L2 and M4 showed good drug release profile and floating behavior. The linear regression and model fitting showed that all formulation followed Higuchi model of drug release model except M4 that followed zero order kinetic. From the study it is evident that a promising controlled release by floating bilyer tablets of lisinopril maleate and metoprolol tartrate can be developed successfully.
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Affiliation(s)
- Hira Ijaz
- College of Pharmacy, Govt. College University Faisalabad, Pakistan
| | - Junaid Qureshi
- College of Pharmacy, Govt. College University Faisalabad, Pakistan
| | - Zeeshan Danish
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Mohamed Abdel-Daim
- Pharmacology Department, Faculty of Veterinary Medicine,Suez Canal University, Ismailia, Egypt
| | | | - Imran Waheed
- Akhtar Saeed college of Pharmaceutical Sciences, Lahore, Pakistan
| | - Imran Shair Mohammad
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
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Abstract
This study examined the influence of preoperative administration of amiodarone and metoprolol in preventing postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) surgery.The study comprised 251 patients who underwent CABG surgery at our hospital between January 2012 and May 2014. The patients were randomly divided into 2 groups: amiodarone therapy group (n = 122 patients) and metoprolol therapy group (n = 129 patients).In the amiodarone group, the patients received amiodarone tablet orally 1 week before coronary bypass surgery and during the postoperative period. In the metoprolol group, the patients received metoprolol tablet orally 1 week before surgery and during the postoperative period. The AF development rate was retrospectively evaluated between the first 3 days and 4 weeks after surgery.AF developed in 14 patients in the amiodarone group and 16 patients in the metoprolol group 4 weeks after the operation (P = 0.612).No significant difference was observed between the groups in terms of intensive care unit and hospital stay. Furthermore, hospital charges were similar in both groups (P = 0.741).The results of the logistic regression analysis showed age, left ventricular ejection fraction, left atrial diameter, and aortic cross-clamping time to be predictors for postoperative AF.This study demonstrates that amiodarone and metoprolol have similar effects in prevention of AF after cardiac surgery. However, larger-scale studies need to be conducted to substantiate these findings.
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Affiliation(s)
- Oruc Alper Onk
- From the Department of Cardiovascular Surgery, Erzincan University Medical Faculty, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
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Abstract
AIM to evaluate ocular hypotensive efficacy of parenteral metoprolol in an experiment. MATERIAL AND METHODS A total of 3 series of experiments on 24 rabbits were performed. The first series involved a single subconjunctival injection of 0.3 mg of metoprolol in the right eye, while the left served as a control. During the second series the rabbits received 0.5 mg of metoprolol intramuscularly. The third series also implied a subconjunctival injection of 0.3 mg of metoprolol in the right eye, however, supplemented with timolol 0.5% instilled in the left. In all rabbits tonometry was performed before the injection and then in 30 min, 1, 2, 3, 6, 8, and 24 hours. Biomicroscopy and ophthalmoscopy were also performed before and 1, 3, and 7 days after the injection. CONCLUSIONS The maximum reduction (down to 30% from the baseline) of intraocular pressure (IOP) was registered in intramuscular metoprolol rabbits. Subconjunctival metoprolol was associated with a faster and more pronounced decrease in IOP as compared to timolol instillations. In case of local or systemic parenteral administration the hypotensive effect of metoprolol lasts for more than a day.
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Affiliation(s)
- A L Onishchenko
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
| | - A V Kolbasko
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
| | - M A Safronova
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
| | - O S Tarash
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
| | - M V Dimaksyan
- Novokuznetsk State Institute of Postgraduate Medicine, Ministry of Health of the Russian Federation, 5 Stroiteley prospekt, Novokuznetsk, Kemerovo Oblast, Russian Federation, 654005
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Ayyappadihas R, Dhanalekshmi U, Jestin H. CYP 2D6*4 polymorphism and interindividual response variation to metoprolol in stage 1 hypertensive patients: no association in a rural Indian population? Turk J Med Sci 2015; 45:352-7. [PMID: 26084127 DOI: 10.3906/sag-1307-133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Genetic polymorphism of CYP2D6 shows diverse pharmacokinetic and pharmacodynamic variation. Therefore, the present work was designed to study the variation in therapeutic responses to metoprolol (MP) in stage 1 hypertensive patients and also aims to verify the association of CYP2D6*4 polymorphism and response variation in an Indian population for the first time. MATERIALS AND METHODS Clinically, a total of 119 hypertensive patients and 116 healthy individuals as controls were included. Patients were treated with MP extended release 25 mg tablets once daily for 2 weeks. Reduction in systolic blood pressure, diastolic blood pressure, and pulse rate were recorded before and after the treatment. For genotyping, genotypes of 89 hypertensive patients and 71 healthy controls were investigated for CYP2D6*4 polymorphism. RESULTS Based on reduction in systolic blood pressure, 26% of the patients did not respond to the MP treatment. Of the patients that responded, 28% responded very slowly, 35% (19 males, 23 females) responded moderately, and 12% (8 males, 6 females) showed a good response to MP. For genotype analysis, we pooled 89 hypertensive patients and 71 controls. No association was found between CYP2D6*4 polymorphism and MP response. CONCLUSION We found no relationship between MP response and CYP2D6*4 genotype in an Indian population in our study.
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Manov A, Gopalakrishnan PP, Subramaniam S, Wardi M, White J. Chest pain · shortness of breath · fever and nausea · Dx? J Fam Pract 2015; 64:282-284. [PMID: 26009736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
| | | | | | - Miraie Wardi
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Justin White
- University of North Texas Health Science Center, Fort Worth, TX, USA
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Abstract
BACKGROUND People undergoing major vascular surgery have an increased risk of postoperative cardiac complications. Beta-adrenergic blockers represent an important and established pharmacological intervention in the prevention of cardiac complications in people with coronary artery disease. It has been proposed that this class of drugs may reduce the risk of perioperative cardiac complications in people undergoing major non-cardiac vascular surgery. OBJECTIVES To review the efficacy and safety of perioperative beta-adrenergic blockade in reducing cardiac or all-cause mortality, myocardial infarction, and other cardiovascular safety outcomes in people undergoing major non-cardiac vascular surgery. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (January 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, Issue 12). We searched trials databases and checked reference lists of relevant articles. SELECTION CRITERIA We included prospective, randomised controlled trials of perioperative beta-adrenergic blockade of people over 18 years of age undergoing non-cardiac vascular surgery. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection and data extraction. We resolved disagreements through discussion. We performed meta-analysis using a fixed-effect model with odds ratios (ORs) and 95% confidence intervals (CIs). MAIN RESULTS We included two studies in this review, both of which were double-blind, randomised controlled trials comparing perioperative beta-adrenergic blockade (metoprolol) with placebo, on cardiovascular outcomes in people undergoing major non-cardiac vascular surgery. We included 599 participants receiving beta-adrenergic blockers (301 participants) or placebo (298 participants). The overall quality of studies was good. However, one study did not report random sequence generation or allocation concealment techniques, indicating possible selection bias, and the other study did not report outcome assessor blinding and was possibly underpowered. It should be noted that several of the outcomes were only reported in a single study and neither of the studies reported on vascular patency/graft occlusion, which reduces the quality of evidence to moderate. There was no evidence that perioperative beta-adrenergic blockade reduced all-cause mortality (OR 0.62, 95% CI 0.03 to 15.02), cardiovascular mortality (OR 0.34, 95% CI 0.01 to 8.32), non-fatal myocardial infarction (OR 0.83, 95% CI 0.46 to 1.49; P value = 0.53), arrhythmia (OR 0.70, 95% CI 0.26 to 1.88), heart failure (OR 1.71, 95% CI 0.40 to 7.23), stroke (OR 2.67, 95% CI 0.11 to 67.08), composite cardiovascular events (OR 0.87, 95% CI 0.55 to 1.39; P value = 0.57) or re-hospitalisation at 30 days (OR 0.86, 95% CI 0.48 to 1.52). However, there was strong evidence that beta-adrenergic blockers increased the odds of intra-operative bradycardia (OR 4.97, 95% CI 3.22 to 7.65; P value < 0.00001) and intra-operative hypotension (OR 1.84, 95% CI 1.31 to 2.59; P value = 0.0005). AUTHORS' CONCLUSIONS This meta-analysis currently offers no clear evidence that perioperative beta-adrenergic blockade reduces postoperative cardiac morbidity and mortality in people undergoing major non-cardiac vascular surgery. There is evidence that intra-operative bradycardia and hypotension are more likely in people taking perioperative beta-adrenergic blockers, which should be weighed with any benefit.
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Affiliation(s)
- Katayoun Mostafaie
- David Geffen School of Medicine at UCLADepartment of Medicine1000 West CarsonTorranceCaliforniaUSA92604
| | - Rachel Bedenis
- University of EdinburghCentre for Population Health SciencesEdinburghUKEH8 9AG
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Hayek SS, Poole JC, Neuman R, Morris AA, Khayata M, Kavtaradze N, Topel ML, Binongo JG, Li Q, Jones DP, Waller EK, Quyyumi AA. Differential effects of nebivolol and metoprolol on arterial stiffness, circulating progenitor cells, and oxidative stress. ACTA ACUST UNITED AC 2014; 9:206-13. [PMID: 25681236 DOI: 10.1016/j.jash.2014.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/16/2022]
Abstract
Unlike traditional beta receptor antagonists, nebivolol activates nitric oxide. We hypothesized that therapy with nebivolol compared with metoprolol would improve arterial stiffness, increase levels of circulating progenitor cells (PC), and decrease oxidative stress (OS). In a randomized, double-blind, cross-over study, 30 hypertensive subjects received either once daily nebivolol or metoprolol succinate for 3 months each. Pulse wave velocity and augmentation index were measured using tonometry. Flow cytometry was used to measure circulating PC. OS was measured as plasma aminothiols. Measurements were performed at baseline, and repeated at 3 and 6 months. No significant differences were present between the levels of OS, arterial stiffness, and PC numbers during treatment with metoprolol compared with nebivolol. In subgroup analyses of beta-blocker naïve subjects (n = 19), nebivolol reduced pulse wave velocity significantly compared with metoprolol (-1.4 ± 1.9 vs. -0.1 ± 2.2; P = .005). Both nebivolol and metoprolol increased circulating levels of CD34+/CD133 + PC similarly (P = .05), suggesting improved regenerative capacity.
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Affiliation(s)
- Salim S Hayek
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph C Poole
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert Neuman
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Alanna A Morris
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohamed Khayata
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Nino Kavtaradze
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew L Topel
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose G Binongo
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Qunna Li
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Dean P Jones
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Edmund K Waller
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA.
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Roolvink V, Rasoul S, Ottervanger JP, Dambrink JHE, Lipsic E, van der Horst ICC, de Smet B, Kedhi E, Marcel Gosselink AT, Piek JJ, Sanchez-Brunete V, Ibanez B, Fuster V, Van't Hof AWJ. Rationale and design of a double-blind, multicenter, randomized, placebo-controlled clinical trial of early administration of intravenous β-blockers in patients with ST-elevation myocardial infarction before primary percutaneous coronary intervention: EARLY β-blocker administration before primary PCI in patients with ST-elevation myocardial infarction trial. Am Heart J 2014; 168:661-6. [PMID: 25440793 DOI: 10.1016/j.ahj.2014.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 07/11/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND β-Blockers have a class 1a recommendation in the treatment of patients with ST-elevation myocardial infarctions (STEMIs), as they are associated with a reduced mortality, recurrent myocardial infarction, life-threatening arrhythmias, and with prevention of unfavorable left ventricular remodeling. Whether early administration before primary percutaneous coronary intervention (PCI) of intravenous β-blockers reduces the infarct size in the current era is unknown. HYPOTHESIS We postulate that the early administration of β-blockers will reduce the myocardial infarcted area as assessed by magnetic resonance imaging (MRI) at 30 days. DESIGN In a multinational, multicenter, double-blind, placebo-controlled, randomized trial, patients with symptoms and signs of STEMI and transferred to a hospital for primary PCI will be randomized in a 1:1 fashion to intravenous metoprolol (5 mg twice daily) administration or placebo. Before admission, study treatment will be started as soon as possible after the diagnosis of STEMI. After admission, primary PCI will be performed as per standard of care. After primary PCI, medical treatment will occur as per current guidelines in all patients, including the use of oral β-blockers. The primary end point is the myocardial infarct size as assessed by MRI at 30 days. Based on a superiority design and assuming an 18% relative infarct size reduction (from 28% to 23.5%), 408 patients are required to be enrolled, accounting for 20% drop-out (α = .05 and power = 80%). SUMMARY The EARLY-BAMI trial is a multinational, multicenter, double-blind, placebo-controlled, randomized clinical trial that will investigate the impact of intravenous metoprolol administration before primary PCI for STEMI on myocardial infarct size as measured with MRI at 30 days.
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Affiliation(s)
- Vincent Roolvink
- Isala Klinieken, Department of Cardiology, Zwolle, The Netherlands.
| | - Saman Rasoul
- Isala Klinieken, Department of Cardiology, Zwolle, The Netherlands
| | | | | | - Erik Lipsic
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Iwan C C van der Horst
- University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, The Netherlands
| | - Bart de Smet
- Meander Medisch Centrum, Department of Cardiology, Amersfoort, The Netherlands
| | - Elvin Kedhi
- Isala Klinieken, Department of Cardiology, Zwolle, The Netherlands
| | | | - Jan J Piek
- Academic Medical Center, Department of Cardiology, Amersfoort, The Netherlands
| | | | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain; The Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY
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Rossi Neto JM, Gun C, Ramos RF, de Almeida AFS, Issa M, Amato VL, Dinkhuysen JJ, Piegas LS. Myocardial protection with prophylactic oral metoprolol during coronary artery bypass grafting surgery: evaluation by troponin I. Braz J Cardiovasc Surg 2014; 28:449-54. [PMID: 24598948 PMCID: PMC4389427 DOI: 10.5935/1678-9741.20130074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/10/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Biochemical markers of myocardial injury are frequently altered after cardiac surgery. So far there is no evidence whether oral beta-blockers may reduce myocardial injury after coronary artery bypass grafting. OBJECTIVE To determine if oral administration of prophylactic metoprolol reduces the release of cardiac troponin I in isolated coronary artery bypass grafting, not complicated by new Q waves. METHODS A prospective randomized study, including 68 patients, divided in 2 groups: Group A (n=33, control) and B (n=35, beta-blockers). In group B, metoprolol tartrate was administered 200 mg/day. The myocardial injury was assessed by troponin I with 1 hour and 12 hours after coronary artery bypass grafting. RESULTS No significant difference between groups regarding pre-surgical, surgical, complication in intensive care (15% versus 14%, P=0.92) and the total number of hospital events (21% versus 14%, P=0.45) was observed. The median value of troponin I with 12 hours in the study population was 3.3 ng/ml and was lower in group B than in group A (2.5 ng/ml versus 3.7 ng/ml, P<0,05). In the multivariate analysis, the variables that have shown to be independent predictors of troponin I release after 12 hours were: no beta-blockers administration and number of vessels treated. CONCLUSION The results of this study in uncomplicated coronary artery bypass grafting, comparing the postoperative release of troponin I at 12 hours between the control group and who used oral prophylactic metoprolol for at least 72 hours, allow to conclude that there was less myocardial injury in the betablocker group, giving some degree of myocardial protection.
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Affiliation(s)
- João Manoel Rossi Neto
- Correspondence address: João Manoel Rossi Neto, Instituto Dante
Pazzanese de Cardiologia, Ambulatório novo-Setor de Disfunção Ventricular, Av. Dante
Pazzanese, 500 - Vila Mariana - São Paulo, SP, Brazil - Zip code: 04012-180. E-mail:
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Critical conversations after coronary artery bypass grafting: balancing the evidence and dealing with uncertainty. Circ Cardiovasc Qual Outcomes 2014; 7:783-4. [PMID: 25097212 DOI: 10.1161/CIRCOUTCOMES.114.000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Rinaldi B, Capuano A, Gritti G, Donniacuo M, Scotto Di Vettimo A, Sodano L, Rafaniello C, Rossi F, Matera MG. Effects of chronic administration of β-blockers on airway responsiveness in a murine model of heart failure. Pulm Pharmacol Ther 2014; 28:109-13. [PMID: 24769100 DOI: 10.1016/j.pupt.2014.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/29/2014] [Accepted: 04/11/2014] [Indexed: 12/21/2022]
Abstract
Lung function abnormalities, both at rest and during exercise, are frequently observed in patients with chronic heart failure (HF), also in absence of respiratory disease. It has been documented that, in HF, chronic adrenergic stimulation down-regulates β-adrenoceptors (β-ARs) and modifies airway relaxant responses. This study was designed to investigate in an animal model of HF whether a treatment with a β-AR blocker, metoprolol, could modify the altered airway hyperresponsiveness. In rats, randomly assigned to 3 experimental groups sham-operated rats (SH), rats with HF induced by left anterior descending coronaric occlusion (HF n = 10), and rats treated with metoprolol 100 mg/kg/die (MET = 10), HF was evaluated after 10 weeks and resulted in increases in plasma norepinephrine and epinephrine and left ventricular end diastolic pressure. β2-ARs and G-protein-βAR2-kinase (GRK2) mRNA levels were determined by real time reverse transcriptase PCR. Carbachol-precontracted isolated tracheal rings were used to functionally assess airway smooth muscle relaxation. In pulmonary tissues, β2-AR mRNA level was significantly decreased in HF groups (-48.73 ± 5.18%, P < 0.01); in the same groups the GRK2 mRNA-levels were significantly enhanced (+222.50 ± 6.13%, P < 0.001); in lung deriving from MET groups the levels of mRNA were significantly increased (+339.86 ± 11.26%, P < 0.001), while the GRK2 mRNA-levels unchanged (-59.02 ± 3.97%, P < 0.001), when compared to SH groups. Relaxation of tracheal strips in response to salbutamol was significantly reduced in HF groups; in tracheal rings, deriving from MET groups, the relaxant effects of salbutamol were significantly enhanced (SH, Emax: 34.87 ± 2.98%, pD2: 7.45 ± 0.27; HF, Emax: 34.87 ± 2.98%, pD2: 7.45 ± 0.27; MET, Emax: 85.43 ± 6.80%, pD2: 6.95 ± 0.59, P < 0.001). In HF, the down-regulation of pulmonary β-ARs results in a significant attenuation of airway relaxation. These effects have been reversed by a treatment with metoprolol, suggesting a potential role of β-AR blockers in the treatment of patients suffering from HF and chronic obstructive airway diseases.
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Affiliation(s)
- B Rinaldi
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy; Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy
| | - A Capuano
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy; Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy
| | - G Gritti
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy
| | - M Donniacuo
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy
| | - A Scotto Di Vettimo
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy
| | - L Sodano
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy
| | - C Rafaniello
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy; Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy
| | - F Rossi
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy; Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy
| | - M G Matera
- Centre of Excellence for Cardiovascular Diseases, Dept. of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Italy.
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Inoue S, Shimizu M, Arita K, Akimoto K. The effect of AST-120 on the single-dose pharmacokinetics of metoprolol extended-release tablets in healthy subjects. ACTA ACUST UNITED AC 2014; 29:115-21. [PMID: 24643911 DOI: 10.1515/dmdi-2013-0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/05/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND This was a randomized, open-label, three-way crossover study to assess the effects of AST-120 (an orally administered spherical carbon adsorbent acting in the gastrointestinal tract without systemic circulation) on the single-dose pharmacokinetics of metoprolol in an extended-release formulation (metoprolol ER) in healthy volunteers. METHODS A total of 34 subjects were singly administered metoprolol ER alone (A), and metoprolol ER in combination with AST-120 simultaneously (B) and 1 h later (C). RESULTS The total exposure was more significantly reduced in both treatments B and C than that in treatment A; the geometric mean ratios of area under the curve extrapolated to infinity (AUC0-∞) for B/A and C/A were reduced by approximately 30% in both treatments B and C. Maximum observed plasma concentration (Cmax) of metoprolol in treatment B significantly decreased, whereas Cmax in treatment C was slightly decreased. AST-120 treatment was unlikely to affect apparent first-order terminal elimination half-life (T1/2) of metoprolol significantly. Reduction in heart rate and blood pressure readings were similar across the treatment periods. Coadministration of AST-120 and metoprolol ER was safe and was well tolerated. CONCLUSIONS Because AST-120 reduced gastrointestinal absorption of metoprolol ER, careful monitoring of heart rate and blood pressure is recommended in coadministration of AST-120 with metoprolol ER.
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42
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Maragkoudakis S, Patrianakos A, Kallergis E, Parthenakis F, Vardas P. Echocardiographic demonstration of coronary artery to left ventricle fistulas: case report and review of the literature. Hellenic J Cardiol 2014; 55:171-173. [PMID: 24681797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
We describe the case of a 45-year-old female patient with coronary fistulas arising from both the left and right coronary artery system and emptying in the left ventricle. Only sporadically do coronary artery fistulas drain into the left ventricle. In our patient, the most likely explanation of the fistulous communications was a congenital cause. We review the literature on coronary cameral fistulas and discuss the etiology of the diagnostic findings. Small coronary artery fistulas are generally well-tolerated and should impose no significant restriction on daily routine and activities. Nevertheless, small fistulas may under certain conditions produce a "steal" phenomenon and shunt blood flow away from the myocardial capillary network, causing ischemia.
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43
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Furuichi Y, Sakamoto A. [Perioperative cardiovascular evaluation and management for noncardiac surgery]. Masui 2014; 63:287-295. [PMID: 24724438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
As a population ages, an increase in the number of patients with cardiac complications who undergo non-cardiac surgeries is observed. The perioperative mortality for noncardiac surgery is approximately 1-5%; approximately 20-35% of these cases are due to cardiovascular complications. Among them, perioperative myocardiac infarction/ischemia is a factor that leads to poor prognosis, and the ACC/AHA guidelines emphasize this aspect. An important task of the anesthesiologist is to accurately assess risks in patients undergoing noncardiac surgeries and avoid adverse cardiovascular events.
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Nelipa EA, Salamatina LV, Urvantseva IA, Karnysheva SI, Raĭkovskaia LR. [A case of diagnosis of asymmetric apical hypertrophic cardiomyopathy of the left ventricle with intraventricular obstruction]. TERAPEVT ARKH 2014; 86:72-74. [PMID: 24864471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The paper describes a case of diagnosis of one of the rare forms of myocardial hypertrophy--asymmetric hypertrophic cardiomyopathy with isolated hypertrophy of the cardiac apex (an apical form) and intraventricular obstruction. It discusses problems in the diagnosis of rare forms of hypertrophic cardiomyopathy.
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45
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Makiev RG, Alanichev AE, Shachnovich PG, Rakhimova OI, Ovchinnikov IV, Fisun AI. [Evaluation of myocardial perfusion by single-photon emission CT in the treatment with beta-adrenoblockers and calcium channel blockers]. Klin Med (Mosk) 2014; 92:20-26. [PMID: 25782317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Single-photon emission CT of the heart was used to observe coronary blood flow and reveal the maximum perfusion region in patients with coronary heart disease (CHD) treated with beta-adrenoblockers and calcium channel blockers. Dynamic observation showed changes and redistribution of myocardial perfusion. Specific features of coronary blood flow were demonstrated depending on the therapeutic modality (beta-blocker metoprolol, calcium channel blocker amlodipine). Parameters of prognostic value were identified depending on the effectiveness of the agents used. This approach together with the traditional nosological one to the choice of CHD therapy permits to individualize the therapeutic influence depending on myocardial micriocirculatory features, such as the spread and depth of perfusion disturbances.
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Liu J, Jadhav P, Wang Y, Gobburu J. Improper selection of a pre-specified primary dose-response analysis delays regulatory drug approval. AAPS J 2013; 15:407-14. [PMID: 23307587 PMCID: PMC3675735 DOI: 10.1208/s12248-012-9438-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/05/2012] [Indexed: 11/30/2022] Open
Abstract
Dose-response analysis is one of the accepted efficacy endpoints to establish effectiveness. The purpose of this research was to inform selection of an appropriate pre-specified primary dose-response analysis to demonstrate drug efficacy in a registration trial. The power and the type I error rate of the placebo-corrected (i.e., simply adjusting the observed treatment value by subtracting the placebo mean) and the placebo-anchored (i.e., including the placebo data as dose 0 in the regression) slope analyses were assessed based on regulatory submission data for two antihypertensive drugs and simulated data from hypothetical clinical trials. In the simulated hypothetical trials, the impact of different dosing strategies (i.e., the fixed dose versus the weight-based per kilogram dose), sample size, and scenarios governing the drug exposure-response relationship (e.g., E(max), ED(50), and SD) was also evaluated. For each scenario, a total 300 replications were simulated. The placebo-anchored slope analysis is always more powerful to demonstrate effectiveness in all plausible scenarios. The difference between the placebo-anchored and the placebo-corrected analyses was maximum when the studied doses were too high. However, the dose-response analysis is not sensitive to the dosing strategies. Furthermore, the type I error rate of these two methods was also found to be comparable. The design of dose-response studies should carefully consider these results to justify the inclusion of placebo and the analysis method. The pharmaceutical industry and the regulatory agencies are equally responsible for using the appropriate methods of primary analysis and providing justification in the protocol.
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Affiliation(s)
- Jiang Liu
- Division of Pharmacometrics, Office of Clinical Pharmacology, CDER, FDA, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
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Franssen C, Wollersheim H, de Haan A, Thien T. The Influence of Different Beta-Blocking Drugs on the Peripheral Circulation in Raynaud's Phenomenon and in Hypertension. J Clin Pharmacol 2013; 32:652-9. [PMID: 1353506 DOI: 10.1002/j.1552-4604.1992.tb05777.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In a double-blind, randomized, placebo-controlled study, the authors investigated the effects of different beta-adrenoceptor blocking drugs on the peripheral circulation. A single intravenous injection of the nonselective beta-blocker propranolol (0.20 mg/kg), the beta 1-selective adrenoceptor blocker metoprolol (0.25 mg/kg), and the nonselective beta-blocker with partial agonistic activity (PAA) pindolol (0.04 mg/kg) and of placebo (saline) was given to eight patients with a primary Raynaud's phenomenon and to nine untreated patients with primary hypertension. The authors measured finger skin temperature (FST), and laser Doppler estimated finger skin blood flux (LDF) before, during, and after a standardized finger cooling test, performed 25 minutes after the administration of the drugs. In both patients groups propranolol, metoprolol, and pindolol had no significant effect on FST and LDF in the first 25 minutes after administration both in comparison to baseline value and to placebo. Also, no significant differences were found in the recoveries of FST and LDF after cold challenge between all drugs and placebo in both groups. The authors conclude that no adverse effect of any type of beta-adrenoceptor blocker in comparison to placebo could be detected after a single administration on both the baseline finger skin perfusion and the recovery after cold-induced vasoconstriction. In addition, the authors could not demonstrate a favorable effect of beta 1-selectivity or PAA in comparison to a nonselective beta-adrenoceptor blocker without PAA, in any group.
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Affiliation(s)
- C Franssen
- Department of Medicine, St. Radboud University Hospital Nijmegen, The Netherlands
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Cotarlan V, Brofferio A, Gerhard GS, Chu X, Shirani J. Impact of β(1)- and β(2)-adrenergic receptor gene single nucleotide polymorphisms on heart rate response to metoprolol prior to coronary computed tomographic angiography. Am J Cardiol 2013; 111:661-6. [PMID: 23261005 DOI: 10.1016/j.amjcard.2012.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/18/2022]
Abstract
A slow, steady heart rate (HR) is necessary for optimal image quality during coronary computed tomographic angiography. Beta blockers are often used, but the goal HR is not achieved in some patients. The aim of this study was to examine the influence of single-nucleotide polymorphisms (SNPs) of the β(1) (codons 49 and 389) and β(2) (codons 16, 27, and 164) adrenergic receptor (AR) genes on HR response to metoprolol in 200 adults (mean age 56 ± 11 years) referred for coronary computed tomographic angiography (using a 64-slice scanner). Oral and intravenous (IV) metoprolol was given to achieve a goal HR of <60 beats/min. Overall, 37 patients (18.5%) did not reach the goal HR despite the administration of oral (181 ± 116 mg) and IV (4.2 ± 9.4 mg) metoprolol. Patients with the β(1)-AR Ser49Gly or Gly49Gly genotype (n = 49) more often failed to reach an optimal HR compared to those with the Ser49Ser genotype (n = 151) (29% vs 15%, p = 0.04), despite receiving higher doses of oral (210 ± 115 vs 172 ± 115 mg, p = 0.048) and IV (7 ± 13 vs 3 ± 8 mg, p = 0.02) metoprolol. Similarly, patients with the β(1)-AR Gly389Gly genotype (n = 11) more often failed to reach an optimal HR compared to those with the Arg389Arg and Arg389Gly genotypes (n = 189) (45% vs 17%, p = 0.02), despite receiving higher doses of IV (13 ± 15 vs 4 ± 9 mg, p = 0.002) but not oral (162 ± 105 vs 182 ± 117 mg, p = 0.50) metoprolol. Multivariate analysis identified β(1)-AR SNPs at codons 49 and 389 and β(2)-AR SNP at codon 27 as independent predictors of suboptimal HR response. In conclusion, these data indicate that the selected SNPs of β(1)-AR and β(2)-AR genes influence HR response to metoprolol in patients who undergo coronary computed tomographic angiography.
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MESH Headings
- Adrenergic beta-Antagonists/administration & dosage
- Adult
- Aged
- Aged, 80 and over
- Coronary Angiography/methods
- Coronary Artery Disease/diagnostic imaging
- Coronary Artery Disease/drug therapy
- Coronary Artery Disease/genetics
- DNA/genetics
- Female
- Genotype
- Heart Rate/genetics
- Humans
- Male
- Metoprolol/administration & dosage
- Middle Aged
- Polymorphism, Single Nucleotide
- Prospective Studies
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-1/metabolism
- Receptors, Adrenergic, beta-2/genetics
- Receptors, Adrenergic, beta-2/metabolism
- Tomography, X-Ray Computed
- Young Adult
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Affiliation(s)
- Vlad Cotarlan
- Department of Cardiology, Geisinger Medical Center, Danville, PA, USA
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49
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Vertkin AL, Morozov SN, Fedorov AI. [Experience in the pre-hospital treatment of acute coronary syndrome with metoprolol succinate]. Klin Med (Mosk) 2013; 91:31-35. [PMID: 23789449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patients with acute coronary syndrome and elevated ST segment in the pre-hospital phase were treated with metoprolol succinate (MS) and thrombolytic therapy. Severe and moderate pain decreased by 54.1 and 16.1% respectively within 60 min after MS intake. Systolic (SAP) and diastolic (DAP) arterial pressure dropped by 35.7 and 16.8 mmHg during the same period. The heart rate (HR) decreased by 25.1 beats/min. 21.8 and 25.3% of the patients showed positive dynamics of ST segment 90 and 180 min after intake of MS. The height of the ST segment was normal in 18.4 and 31.0% of the patients respectively. No cases of external heart rupture were documented at autopsy whereas it was a cause of death in 39.1% of the patients given standard thrombolytic therapy. It is concluded that the use of MS starting from the pre-hospital stage in patients with acute coronary syndrome decreases pain intensity. HR, DAP and SAP and helps to prevent heart rupture.
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50
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Svistov AS, Sukhov VI, Makiev RG, Alanichev AE. [Use of SPECT-scanning of the heart in estimating of influence of drugs of the background therapy of ischemic heart disease on myocardial perfusion]. Voen Med Zh 2012; 333:27-36. [PMID: 23213770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Some new facts about the influence of different groups of drugs on myocardial perfusion were educed during the research. Educed facts conduce representation extension by matching the optimal therapy of ischemic heart disease. With the help of SPECT-scanning were educed myocardial blood flow, areas of maximal hypoperfusion and its influence on time pattern and redistribution of myocardial blood flow in patients receiving disease-modifying agents and statins. Some regularities of change of myocardial blood flow depending on applied group of drugs and peculiarities of influence of myocardial perfusion in certain time interval were revealed. Criteria with prognostic significance in prospective individual effectiveness of anti-ischemic drugs were pointed out. New approach, based on choice of anti-ischemic therapy depending on extent of influence on myocardial perfusion and also individual clinical and functional traits of patients, was applied.
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