Effect of Oral Hexamethonium Salts on Gastric Secretion

Abstract

Hexamethylene-bistrimethyl-ammonium (hexamethonium) iodide (C6) has been shown by Paton and Zaimis (1949) to exert a blocking effect at the synapses of autonomic ganglia. In a previous paper (Kay and Smith, 1950) we have shown that this compound, when given intramuscularly, inhibits the gastric secretion and motility. In the present paper we give the results obtained with the same drug administered by mouth, and also compare the effects of the other halides.In the first series of experiments we have observed the effect of a single dose of the iodide salt on the gastric secretion; in the second, the effect of repeated administration; and in the third, the comparative effects of equivalent doses of the iodide, bromide, and chloride.Effect on Spontaneous Gastric Secretion Ten male patients with duodenal ulceration were selected for study. Cases of peptic ulcer complicated by organic stenosis were excluded, since it was felt that the use of hexamethonium iodide would exaggerate gastric retention. Secretion tests were begun at 9 a.m., after a 12-hour fasting period. In the control test, specimens were aspirated every 30 minutes for a period of three hours. On the following day 500 mg. of the drug was given by stomach tube immediately on removal of the fasting juice. After one hour specimens were aspirated at 30-minute intervals. This method was used for six patients. In the other four, to avoid aspiration of unabsorbed drug retained in the stomach, the first aspiration was delayed until two hours after giving the drug.At each aspiration the stomach was emptied, and the volume, bile staining, and titratable free ml. Nil hydrochloric acid were noted. All saliva was % expectorated. It will be seen from Figs. 1 60 and 2 that achlorhydria was reached in five patients, being of short duration in three and 40 lasting four hours in the other two. Of the remainder, three patients showed an appre-500 20 ciable fall in the level of acidity. Two, how-C6 ever, showed no significant change. That the reduction of acidity was due to diminished -2 -21 secretion and not to regurgitation of duodenal juice was indicated by the small volume of the 80 fluid withdrawn and the absence of bile. Effect of a Repeated Dose on SpontaneousGastric Secretion In view of the variable results noted above, it seemed desirable to determine if consistent results were obtained in individual patients. With this in view 500 mg. of hexamethonium iodide was administered to four patients on two successive occasions and the results compared with preliminary and final controls. As in the first group, the drug was given

Reduction of Surgical Haemorrhage

“…The hypotensive action of the "middle " numbers of the group, first indicated by Organe when studying pentamethonium as an antidote to decamethonium, has been exploited by several workers in the treatment of hypertension (Campbell and Robertson, 1950;Turner, 1950;Saville, 1950). The action of hexamethonium on gastric secretion has been reported upon by Kay and Smith (1950), as well as by other workers. Armstrong Davison (1950) and Enderby (1950) have reported on the use of drugs of the group to produce hypotension during surgery in order to obtain reduced bleeding.…”

Methonium Compounds in the Treatment of Hypertension

“…We do not doubt that the acute hypotensive effects would occur, but it is interesting to speculate on what effect the absence of the sedative action of the bromide ion would have on the results. Kay and Smith (1950) in their work have found the chloride less active when given orally. A related drug with a more potent effect, and therefore used in smaller dosage, and containing the bromide ion would give lower serum-bromide levels and make the possibility of bromide intoxication much less likely.…”

Newer Drugs in the Treatment of Hypertension

“…Three patients developed mild proteinuria. Of 40 patients with normal renal function initially, 3 developed slight impairment of function as evidenced by well-controlled phenolsulfonphthalein tests. Two of 10 patients with impaired renal function showed progressive renal damage and death.…”