Drug plasma levels and coronary vasodilation after isosorbide dinitrate chewing capsules

S, Jost; Rafflenbeul, W.; Knop, I.; Bossaller, Claus; Gulba, Dietrich C.; Hecker, Hartmut; Lippolt, Peter; Lichtlen, Paul R.

doi:10.1093/eurheartj/10.suppl_f.137

Cited by 15 publications

(5 citation statements)

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“…Coronary dilation was most pronounced in smaller epicardial coronary arteries, as has ah'eady been described for several vasodilating substances [24,25,27,281. The reasons for the ga'eater dilatory response of smaller coronary arteries are still unknown; it is known that, in relation to the luminal cross section, smaller arteries have a thicker muscular ring than larger arteries, allowing gTeater percentage changes in the luminal diameter.…”

Section: Discussionsupporting

confidence: 57%

“…Therefore, dilation of epicardial coronary stenoses that are still capable of vasomotility, i.e., reduction of "proximal" coronary resistance, plays an important role in the actions of al~tianginal drugs [14,[21][22][23]. In addition to nitrocompounds [14,[21][22][23][24], calcium antagonists, particularly nifedipine, have been 1)roven to be potent dilators of epicardiai coronary arteries, and l)articularly stenoses 114, 15, 25]; these compounds also represent powerful drugs in the treatment of coronary vasospasm [23,26].…”

Section: Discussionmentioning

confidence: 99%

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Vasodilatory effects of nisoldipine on coronary arteries—Correlation with plasma levels

Jost

Rafflenbeul

Mogwitz

et al. 1990

Cardiovasc Drug Ther

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Vasomotion of angiographically normal and stenotic epicardial coronary arteries was analyzed up to 15 minutes after the onset of an intravenous infusion (4 minutes) of 0.5 mg (13 patients, group A) or 1 mg nisoldipine (13 patients, group B). After both doses the maximal increase of the mean diameters of normal coronary segments was achieved not before the 15th minute, averaging 11 +/- 6% in group A (p less than 0.001) and 18 +/- 9% in group B (p less than 0.001). Eleven of 15 and 8 of 9 coronary stenoses in groups A and B dilated to 5-80% and 15-70%, respectively. The nisoldipine concentration reached maximal levels at the end of the infusion (fourth minute) with an average of 8 +/- 4 ng/ml and 17 +/- 7 ng/ml in groups A and B, respectively. A significant correlation between nisoldipine plasma levels and dilation of normal coronary segments was obtained only with the individual maxima of these parameters and only in group A (p less than 0.01). The hysteresis of the coronary dilation in relation to the drug plasma levels may be due to the high receptor affinity of nisoldipine. In either group nisoldipine provoked a persistent increase in coronary sinus oxygen saturation (p less than 0.01) and a substantial and prolonged drop in systolic and diastolic aortic pressure (p less than 0.001). Both doses of nisoldipine induced a rise in heart rate (p less than 0.01) and a slight drop in the rate-pressure product (p less than 0.05).

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Vasodilatory effects of nisoldipine on coronary arteries—Correlation with plasma levels

Jost

Rafflenbeul

Mogwitz

et al. 1990

Cardiovasc Drug Ther

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“…There is evidence from other quantitative coronary angiographic studies that the maximal coronary dilation that can be achieved with nitrocompounds amounts to an average of approximately 30% [2,3,7,19]. Also, in group II of this paper, an average dilation of 25% was observed after sublingual administration of 0.8mg nitroglycerin.…”

Section: Discussionsupporting

confidence: 50%

“…It was the purpose of study no. III to induce a reproducable, maximal degree of coronary dilation with a group of drugs with identical mechanisms of action; for these purposes, high doses of the nitrocompounds SIN-1 and nitroglycerin were chosen, since nitrates are well-known coronary vasodilators [1][2][3]19].…”

Section: Ad2)mentioning

confidence: 99%

Elimination of variable vasomotor tone in studies with repeated quantitative coronary angiography

et al. 1990

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In quantitative coronary angiographic studies, unintentional changes of coronary vasomotor tone may have a significant influence on the coronary artery diameters, thereby increasing the variability in the measurements. To obtain objective data on these measurement variabilities, two protocols were designed to assess the influences of ionic and nonionic radiographic contrast media on the mean diameters of angiographically normal coronary arteries. The vessel sizes were determined with the CAAS using automated edge detection techniques. In 21 patients (study no. I), coronary angiograms were taken in identical angiographic projections before (control), and immediately following several (at average 7) subsequent diagnostic dye injections administered over a period of about 7 min. The ionic contrast agent diatrizoate 76% induced a coronary dilation of 19 +/- 7% (mean +/- s.d., p less than 0.001; n = 10); the nonionic agent iopromide 370 increased the coronary artery diameters by only 6 +/- 4% (p less than 0.01; n = 11). In another 11 patients (study no. II) coronary angiograms were obtained using the nonionic contrast medium iopamidol 300 at 5, 8, 10 and 11 min after the control acquisition; this protocol was repeated in the same patients with diatrizoate 76%. With iopamidol, coronary diameter changes were not significant at any time; with diatrizoate, however, coronary dilation was measured at 10 min (2 +/- 2%; p less than 0.01) and at 11 min (10 +/- 3%; p less than 0.001). In a third study it was tested, whether standardization of coronary vasomotor tone (e.g. in coronary angiographic follow-up studies) is possible by the induction of a reproducible maximum coronary dilation with nitrocompounds. In 12 patients, the mean diameters of angiographically normal coronary segments were analyzed before and at various times after i.v. administration (over 4 min) of 0.025 mg SIN-1/kg bodyweight. Coronary dilation was maximal at 10 or 15 min after the onset of the SIN-1-infusion (29 +/- 5%; p less than 0.001). 0.8 mg nitroglycerin given s.l. at 15 min did not further dilate the coronary arteries (28 +/- 7%). One hour after SIN-1, coronary dilation still amounted to an average of 24 +/- 8% (p less than 0.001) and became 'maximal' again, when 0.8 mg nitroglycerin was again administered sublingually (28 +/- 8%; p less than 0.001). In conclusion, short-term variability of coronary vasomotor tone induced by ionic radiographic contrast media can be eliminated by the use of nonionic contrast agents and observation of injection intervals of at least 2 min. In quantitative coronary angiographic follow-up studies, as well as during acute interventions (e.g., PTCA), identical baseline vasomotor tone can be achieved by induction of the maximal coronary dilation using nitrocompounds.

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“…For both types of studies, the following acquisition protocols were followed. Immediately prior to each study, a coronary vasodilator (5 mg isosorbide dinitrate sublingually) was administered to standardize the coronary vasomotor tone [14]. In addition, a nonionic contrast agent (Omnipaque® 350) was used.…”

Section: Short-and Medium-term Variabilitiesmentioning

confidence: 99%

Accuracy and precision of quantitative digital coronary arteriography; observer-, as well as short- and medium-term variabilities

Reiber¹,

Zwet²,

Koning³

et al. 1994

Quantitative Coronary Angiography in Clinical Practice

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Drug plasma levels and coronary vasodilation after isosorbide dinitrate chewing capsules

Cited by 15 publications

References 0 publications

Vasodilatory effects of nisoldipine on coronary arteries—Correlation with plasma levels

Vasodilatory effects of nisoldipine on coronary arteries—Correlation with plasma levels

Elimination of variable vasomotor tone in studies with repeated quantitative coronary angiography

Accuracy and precision of quantitative digital coronary arteriography; observer-, as well as short- and medium-term variabilities

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