Investigations of Long-Term Treatment with Perhexiline Maleate Using Therapeutic Monitoring and Electromyography

Systematic Review of the Efficacy and Safety of Perhexiline in the Treatment of Ischemic Heart Disease

“…[40] Symptomatic status improved in 13 of the 15 patients over the first 3 months of perhexiline therapy (p < 0.01) and no patient experienced any adverse effects. Pilcher et al have presented evidence to suggest that symptomatic improvement with perhexiline is positively related to serum drug concentrations: [41] median serum concentrations of 140 μg/L in those with no response; 300 to 610 μg/L in those with some response; and 700 to 840 μg/L in those with a good or very good response. There was wide variability in the serum perhexiline concentrations achieved with any given dosage, indicating large inter-individual variation in metabolism.…”

Therapeutic Monitoring of the Anti-Anginal Drug Perhexiline Maleate

“…Attempts by Shah et al 6 to phenotype the slow and fast metabolisers of the drug using a single debrisoquine loading test proved inconclusive. Following the development of a gas chromatographic procedure for the rapid estimation of serum Px, 7 Pilcher et al 8 have shown that high concentrations of Px in patients can be avoided provided that serum Px concentrations are carefully monitored and that there is a relationship between therapeutic response and serum Px concentrations. This paper reports on the observed differences of Px doses and the corresponding serum Px concentrations obtained between patients, and underlines the importance of monitoring the serum concentration of this drug when used therapeutically.…”

Evaluation of Anti-Ischemic Therapy in Coronary Artery Disease: A Review

“…Perhexiline has been shown to be superior to -adrenoceptor blockers in its ability to reduce the frequency of anginal attacks and in addition, because it has a different mode of action, it provides additional antianginal benefit when added to existing agents (Stewart et al, 1996). Its use declined in the mid 1970s (Horowitz, 1995) because of the occurrence of severe adverse effects during long-term therapy including neuropathy and hepatotoxicity (Cooper et al, 1985). The incidence of these adverse effects was noted to be related to plasma perhexiline concentration and it was observed that adverse effects could be prevented if plasma concentrations were kept below defined values (Pilcher et al, 1985;Horowitz., 1986).…”