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Mexiletine and tocainide: a comparison of antiarrhythmic efficacy, adverse effects, and predictive value of lidocaine testing.
Murray KT, Barbey JT, Kopelman HA, Siddoway LA, Echt DS, Woosley RL, Roden DM
(1989) Clin Pharmacol Ther 45: 553-61
MeSH Terms: Adult, Aged, Aged, 80 and over, Arrhythmias, Cardiac, Drug Evaluation, Drug Resistance, Drug Therapy, Combination, Electric Stimulation, Female, Heart Ventricles, Humans, Lidocaine, Male, Mexiletine, Middle Aged, Prospective Studies, Quinidine, Random Allocation, Tocainide
Show Abstract · Added January 20, 2015
Thirty patients received one of the lidocaine analogues--mexiletine or tocainide--orally for treatment of symptomatic ventricular arrhythmias. Crossover to the other analogue was allowed if initial drug treatment was unsuccessful, and the controlled use of other marketed oral antiarrhythmic agents was permitted. After follow-up of 7 +/- 3 months (SD), mexiletine was successful in 5 of 13 patients initially and in 5 of 14 patients who failed to respond to tocainide. Tocainide was successful in 1 of 17 patients initially and in 2 of 7 who did not respond to mexiletine. Combination therapy was used in nearly half of all ultimately successful drug trials. A common cause of drug trial failure for both drugs was the occurrence of adverse effects that frequently appeared well after hospital discharge. Response to lidocaine was a sensitive but nonspecific predictor of clinical outcome with mexiletine or tocainide that helped to identify drug-resistant patients. Finally, although mexiletine provided effective antiarrhythmic therapy more often than tocainide, response to one lidocaine analogue did not predict response to the other.
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19 MeSH Terms
Suppression of ventricular arrhythmias in man by d-propranolol independent of beta-adrenergic receptor blockade.
Murray KT, Reilly C, Koshakji RP, Roden DM, Lineberry MD, Wood AJ, Siddoway LA, Barbey JT, Woosley RL
(1990) J Clin Invest 85: 836-42
MeSH Terms: Action Potentials, Adult, Aged, Arrhythmias, Cardiac, Blood Pressure, Electrocardiography, Heart Rate, Humans, Male, Middle Aged, Propranolol, Receptors, Adrenergic, beta, Stereoisomerism
Show Abstract · Added January 20, 2015
To investigate the mechanisms of ventricular arrhythmia suppression by propranolol, we determined the antiarrhythmic efficacy of d-propranolol in 10 patients with frequent ventricular ectopic depolarizations (VEDs) and nonsustained ventricular tachycardia. After an initial placebo phase, 40 mg d-propranolol was administered orally every 6 h with dosage increased every 2 d until arrhythmia suppression (greater than or equal to 80% VED reduction), intolerable side effects, or a maximal dosage (1,280 mg/d) was reached. Response was verified by documenting return of arrhythmia during a final placebo phase. Arrhythmia suppression occurred in six patients while two more had partial responses. Effective dosages were 320-1,280 mg/d (mean 920 +/- 360, SD) of d-propranolol with corresponding plasma concentrations of 60-2,280 ng/ml (mean 858 +/- 681). For the entire group, the QTc interval shortened by 4 +/- 4% (P = 0.03). Arrhythmia suppression was accompanied by a reduction in peak heart rate during exercise of 0-29%. To determine whether arrhythmia suppression could be attributed to beta-blockade, racemic propranolol was then administered in dosages producing the same or greater depression of exercise heart rate. In 3/8 patients, arrhythmias were not suppressed by racemic propranolol indicating that d-propranolol was effective via a non-beta-mediated action. By contrast, in 5/8 patients racemic propranolol also suppressed VEDs. We conclude that propranolol suppresses ventricular arrhythmias by both beta- and non-beta-adrenergic receptor-mediated effects.
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13 MeSH Terms
Procainamide-induced respiratory insufficiency after cardiopulmonary bypass.
Putnam JB, Bolling SF, Kirsh MM
(1991) Ann Thorac Surg 51: 482-3
MeSH Terms: Arrhythmias, Cardiac, Cardiopulmonary Bypass, Humans, Male, Middle Aged, Procainamide, Respiratory Insufficiency, Ventilator Weaning
Show Abstract · Added March 27, 2014
A 46-year-old man could not be weaned from ventilatory support while receiving procainamide. When the drug was discontinued, the patient was successfully weaned shortly thereafter.
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8 MeSH Terms
Clinical and regulatory implications of the Cardiac Arrhythmia Suppression Trial.
Pratt CM, Brater DC, Harrell FE, Kowey PR, Leier CV, Lowenthal DT, Messerli F, Packer M, Pritchett EL, Ruskin JN
(1990) Am J Cardiol 65: 103-5
MeSH Terms: Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Cardiac Complexes, Premature, Flecainide, Humans, Randomized Controlled Trials as Topic, United States, United States Food and Drug Administration
Added February 28, 2014
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8 MeSH Terms