Amlodipine versus nadolol in patients with stable angina pectoris

ST Elevation Myocardial Infarction With No Structural Lesions After a Wasp Sting

“…Almost all of the cited substances have an established capacity either to directly induce coronary vasoconstriction or to favor platelet aggregation and thrombosis (3). In our patient, the vasoconstrictive action of these substances may have been enhanced by the lack of the protective counterbalancing vasodilatator effect of amlodipine, a calcium channel blocker with known coronary vasodilatation action that was withdrawn several weeks before the incident (7). This is of particular interest considering the fact that the patient reported having been previously stung by wasps in the same geographic region (assuming it was the same species) but without developing any particular reaction.…”

Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing?A randomized crossover study in comparison with placebo

“…Many reports have indicated that PRP at termination of exercise and at the same exercise time did not exceed and, in fact was slightly lower than, the correponding parameters measured during the observation period [7,11,12]. Therefore, the antianginal effect of amlodipine appears to arise from an inhibitory action upon myocardial oxygen consumption rather than an increase in coronary blood flow.…”

“…Jackson et al [6] reported that on the seventh day of administration of single daily doses of 2.5-10 mg of amlodipine, the exercise time of patients with exertional angina was significantly prolonged, indicating that efficacy is manifested from an early date in the regimen. However, most reports indicate that at least 4 weeks of administration are required in order to properly assess improvement with respect to number of anginal attacks and exercise tolerance [7,[9][10][11][12]. In one study, patients with exertional angina were divided into four groups, receiving single daily doses of 1.25, 2.5, 5, and 10 mg of amlodipine; exercise tests were conducted on the 24th hour after 4 weeks of administration and the results indicated that exercise time was significantly prolonged in the groups receiving 5-and 10-mg doses, as well as verifying that the antianginal action of amlodipine was sustained for 24 hours [10]; the effective 5-mg doses were associated with a peak blood concentration of 6.3 + 0.7 ng/ml on the 14th day of administration [15].…”

“…Owing to its novel pharmacokinetic characteristics, amlodipine may be effective even in single doses for the long-term treatment of hypertension and angina pectoris. The clinical efficacy of single daily doses of 2.5-10 mg of amlodipine in therapy for hypertension [5] and angina pectoris [6][7][8][9][10][11][12] has already been confirmed. However, the manifestation of effective pharmacological action of this drug is slow, 7 days being required for the plasma concentration to attain a steady state [4], and consequently at least 1 week or possibly longer may be necessary for satisfactory efficacy.…”

“…However, the manifestation of effective pharmacological action of this drug is slow, 7 days being required for the plasma concentration to attain a steady state [4], and consequently at least 1 week or possibly longer may be necessary for satisfactory efficacy. There also exist reports concerning the evaluation by exercise tests of the efficacy of amlodipine on the seventh day of administration for the treatment of exertional angina, but the period of administration in the majority of such trials has been 4 weeks [7,[9][10][11][12]. However, the antianginal action of amlodipine and the sustained continuation of this action are necessary from the time of administration of the first dose, and if an effective blood concentration of the drug can be attained from the first day of administration, then adequate antianginal efficacy should be obtainable.…”