Evaluation of potential pharmacodynamic and pharmacokinetic interactions between verapamil and propranolol in normal subjects.

Murdoch, Duncan J.; Thomson, Gd; Thompson, G. G.; Murray, Gordon D.; Brodie, MJ; McInnes, GT

doi:10.1111/j.1365-2125.1991.tb05536.x

Cited by 14 publications

(6 citation statements)

References 49 publications

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“…Here we report a case of rescue venoarterial extracorporeal membrane oxygenation (ECMO) in a newborn with refractory low cardiac output as a result of acute drug toxicity for treatment of paroxysmal supraventricular tachycardia (SVT). The potentially lethal combination of Ca‐channel and β‐receptor antagonists is well defined (7,8), and several fatal cases of poisoning have since been described in adults (9,10). To the best of our knowledge, this is the first report describing use of ECMO in a low cardiac output syndrome caused by combination of Ca‐channel and β‐receptor antagonists as treatment of SVT in a neonate.…”

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confidence: 87%

Rescue Extracorporeal Life Support for Acute Verapamil and Propranolol Toxicity in a Neonate

et al. 2011

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Extracorporeal life support (ECLS) to manage acute antiarrhythmic drugs toxicity in neonates has never been reported. Here presented is a case of venoarterial extracorporeal membrane oxygenation support in a newborn with refractory low cardiac output as a result of acute Ca-channel and β-receptor antagonist toxicity for treatment of paroxysmal supraventricular tachycardia (SVT). Shortly after onset of ECLS, the baby recovered sinus rhythm and subsequent bouts of SVT were controlled by amiodarone infusion and repeated DC shocks. Weaning was possible on the 5th day after implant, once recovery of the left ventricular function and optimization of the antiarrhythmic medication were achieved. In neonates with severe but potentially reversible cardiac dysfunction caused by drug toxicity, ECLS can maintain cardiac output and vital organ perfusion while allowing time for drug redistribution, metabolism, and clearance.

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confidence: 87%

Rescue Extracorporeal Life Support for Acute Verapamil and Propranolol Toxicity in a Neonate

et al. 2011

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“…Verapamil also may influence propranolol pharmacokinetics, decreasing its clearance and increasing its plasma concentration [10].…”

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confidence: 99%

“…Well-known effects of the combination of β-blockers and calcium-channel blockers include depression of myocardial contractility and atrioventricular conduction, bradycardia, asystole, and heart failure [9]. Verapamil also may influence propranolol pharmacokinetics, decreasing its clearance and increasing its plasma concentration [10].…”

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confidence: 99%

Extracorporeal Life Support in Severe Propranolol and Verapamil Intoxication

Kołcz

Pietrzyk

Januszewska

et al. 2007

J Intensive Care Med

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Combined poisoning with calcium-channel blockers and beta-blockers is usually associated with severe heart failure. This report shows the effectiveness of emergency extracorporeal life support in treating life-threatening simultaneous propranolol and verapamil intoxication. A 15-year-old girl presented in cardiogenic shock after alcohol consumption and a propranolol and verapamil overdose; plasma concentrations: propranolol, 0.53 m/mL; verapamil, 1.06 mg/mL. She was successfully resuscitated with extracorporeal life support. Therapeutic plasma exchange was initiated. Extracorporeal support was discontinued 70 hours later. The patient made a full recovery. Simultaneous verapamil and propranolol overdoses can cause severe hemodynamic compromise and arrest of electrical and mechanical function of the heart. Emergency extracorporeal life support can successfully maintain vital organ blood flow and allows time for drug metabolism, redistribution, and removal. Therapeutic plasma exchange may reduce the time of emergency extracorporeal life support. Emergency extracorporeal life support should be considered early in cases of near-fatal intoxications with cardiodepressive drugs.

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“… 35 In another study in the same country, half-life of the drug was reported 4.7±0.9. 36 Although there is a limitation in terms of the low number of participants in our study, the increased clearance and volume of distribution of subjects in our study suggest that the decrease of half-life was a consequence of a more increase in clearance rather than an increase in volume of distribution. In poor metabolizer people, following the administration of certain doses of the drug, there was more increase in the concentration of the drug, longer elimination half-life and an increase in the inhibition of beta.…”

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confidence: 64%

Pharmacokinetic Parameters and Over-Responsiveness of Iranian Population to Propranolol

Salehifar¹,

Ebrahim²,

Shiran³

et al. 2017

Adv Pharm Bull

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Purpose: Propranolol is the most widely used treatment for cardiovascular diseases. Dosage range in our patients is usually less than the amount mentioned in references. The aim of the present study was to clarify whether pharmacokinetic differences are able to justify the need for the fewer doses in our patients or not.Methods: Twenty healthy volunteers (10 male) at heart center of Mazandaran University of Medical Sciences were studied. Samples of blood were collected before a single oral dose (40 mg) of Propranolol. Blood samples were taken up to 9 hours after dose. Total plasma concentration of Propranolol was measured by HPLC. Population Pharmacokinetic analysis was performed using population pharmacokinetics modeling software P-Pharm.Results: The mean value for oral plasma clearance (CL/F) was 126.59 ml/hr. The corresponding values for apparent volume of distribution (V/F), t1/2 beta, maximum blood concentration (C max), and time to reach the maximum blood concentration (T max) were 334.12 Lit, 1.98 hr, 40.25 ng/ml, and 1.68 hr, respectively. The observed mean values of V/F of propranolol in the present study were comparable with those reported in the literature. However, the mean values of CL/F of propranolol in current study was significantly higher than those reported in other population (P-value<0.001).Conclusion: This study has confirmed that the pharmacokinetic differences are not able to justify over-responsiveness of Iranian population to propranolol. Pharmacodynamic differences in responding to beta blocker drugs by Renin secretion or having a different sensibility to beta receptors might play a role in making our population have a different response to propranolol.

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Evaluation of potential pharmacodynamic and pharmacokinetic interactions between verapamil and propranolol in normal subjects.

Cited by 14 publications

References 49 publications

Rescue Extracorporeal Life Support for Acute Verapamil and Propranolol Toxicity in a Neonate

Rescue Extracorporeal Life Support for Acute Verapamil and Propranolol Toxicity in a Neonate

Extracorporeal Life Support in Severe Propranolol and Verapamil Intoxication

Pharmacokinetic Parameters and Over-Responsiveness of Iranian Population to Propranolol

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