Additive antianginal effect of verapamil in patients receiving propranolol

Bassan, Mayer; Weiler-Ravell, Daniel; Shalev, Oded

doi:10.1136/bmj.284.6322.1067

Cited by 14 publications

(10 citation statements)

References 22 publications

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“…These results confirmed earlier observations [38] and were again confirmed by Bassan's group [39] and Leon's group [40]. These observations showed that under controlled clinical settings, the combination of verapamil and a beta blocker was an important addition to the armamentarium in angina treatments, substantiating previous anecdotal reports.…”

Section: Chronic Stable Anginasupporting

confidence: 93%

“…Bassan's group [39] reported on the favorable result they found when combining verapamil and propranolol, which substantiated the results obtained by Subramanian. Similar results were reported by Sagirov et al [57] in 27 angina patients, and they proposed that a synergism exists in the antianginal action, resulting in a further reduction in the myocardial oxygen requirement.…”

Section: Chronic Stable Anginasupporting

confidence: 89%

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Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Lessem

Singh

1989

Cardiovasc Drug Ther

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Calcium-channel antagonists and beta-adrenergic blocking agents have become important modalities in the cardiovascular therapeutic armamentarium. These drugs are often administered as monotherapy to a wide range of cardiological patients with angina pectoris, hypertension, arrhythmias, congestive heart failure, and other diseases. Since within each class these drugs exhibit pharmacologic differences, it follows that their effectiveness varies in different disease states and that they exhibit a wide variety of side effects. In an attempt to optimize therapy, the individual drugs from these two classes can be combined; and the efficaciousness and side-effect profile of various combinations between calcium-channel antagonists and beta blockers are discussed in this review. Recommendations as to which patients may benefit from a combination and as to which patients may be harmed by the combination therapy will be made. Very few studies have compared the safety and efficacy of a single agent with the combination and with placebo in a controlled randomized fashion. To determine which therapy is superior and to determine which combination one should recommend under what circumstances, such placebo-controlled, randomized trials are a necessity, and will hopefully be performed although the complexity is enormous.

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Section: Chronic Stable Anginasupporting

confidence: 93%

Section: Chronic Stable Anginasupporting

confidence: 89%

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Lessem

Singh

1989

Cardiovasc Drug Ther

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“…However, experience with the combination is limited because of fears that it may be associated with serious cardiac side effects. Shortterm studies have confirmed the efficacy of this combination without significant toxicity (Leon et al, 1981;Bassan et al, 1982). The only reported chronic study using this combination in angina supports the findings of shorter studies with drug withdrawal in only one of 14 patients because of mild heart failure (Bala Subramanian et al, 1982b).…”

Section: Discussionmentioning

confidence: 64%

“…This is because ofthe theoretical risk of an interaction between beta-blockers and verapamil which may predispose to cardiac failure or heart block. Although such complications have occurred particularly after intravenous use of these agents (Lewis, 1981;Packer et al, 1982a;Packer et al, 1982b;Kieval et al, 1982) recent short-term studies have suggested that combined oral therapy is both safe and effective (Leon et al, 1981;Bassan et al, 1982). However, there is little information on the long-term tolerability of this combination in a relatively unselected group of patients.…”

Section: Introductionmentioning

confidence: 99%

Tolerability of combined treatment with verapamil and beta-blockers in angina resistant to monotherapy

McGourty

Silas

Solomon

1985

Postgraduate Medical Journal

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Summary:We have used a combination of a beta-blocker and verapamil to treat 42 consecutive patients with angina resistant to either agent alone. Patients with heart failure, heart block or uncontrolled hypertension were excluded. The mean duration of follow-up was 6.5 months. Thirty-six patients (81%) reported an improvement and the number of angina attacks was reduced from 17/week to 5/week. Side effects necessitated withdrawal of one or both drugs in 6 patients, 2 of whom developed bradyarrhythmias not solely related to drug treatment. The most common complication was mild left ventricular failure (6) treated by reducing or stopping the beta-blocker. The data suggest that the combination ofverapamil and a beta-blocker may be used in a relatively unselected group of patients with difficult angina. However, as dosage adjustment and close observation may be necessary to minimise side effects, the use of this combination should be limited to hospital practice.

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“…There are therefore no pharmacokinetic contraindications to combining nifedipine with these two P-adrenoceptor blockers. The intersubject variability of nifedipine pharmacokinetic parameters can be judged from the standard deviations in (Dargie et al, 1981;Bassan et al, 1982). The possibility of both pharmacokinetic and pharmacodynamic interactions suggests caution when combining these different drugs.…”

Section: Discussionmentioning

confidence: 99%

Lack of a pharmacokinetic interaction between nifedipine and the beta‐ adrenoceptor blockers metoprolol and atenolol.

Kendall¹,

DeRuiter²,

Laugher³

et al. 1984

Brit J Clinical Pharma

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Nifedipine, metoprolol and atenolol were administered orally to young, healthy volunteers. Each drug was given alone and nifedipine was also given with both beta‐adrenoceptor blockers. Each drug was given for 3 days immediately before the study days. Plasma and urine drug concentrations were measured and the relevant pharmacokinetic parameters calculated. No pharmacokinetic interaction between nifedipine and the beta‐adrenoceptor blockers was revealed.

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Additive antianginal effect of verapamil in patients receiving propranolol

Abstract: Ten men with stable angina pectoris not fully relieved by optimal doses of propranolol (mean 218 mg daily) were given a single oral dose of 120 mg verapamil or a placebo on alternate mornings; the order of treatment was double blind.

Cited by 14 publications

References 22 publications

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Tolerability of combined treatment with verapamil and beta-blockers in angina resistant to monotherapy

Lack of a pharmacokinetic interaction between nifedipine and the beta‐ adrenoceptor blockers metoprolol and atenolol.

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