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Carvedilol bradycardia

R Schwarzer, D Kivaranovic, R Paternostro, M Mandorfer, T Reiberger, M Trauner, M Peck-Radosavljevic, A Ferlitsch
BACKGROUND: Sequential measurements of hepatic venous pressure gradient (HVPG) are used to assess the haemodynamic response to nonselective betablockers (NSBBs) in patients with portal hypertension. AIMS: To assess the rates of HVPG response to different doses of carvedilol. METHODS: Consecutive patients with cirrhosis undergoing HVPG-guided carvedilol therapy for primary prophylaxis of variceal bleeding between 08/2010 and 05/2015 were retrospectively included...
April 2018: Alimentary Pharmacology & Therapeutics
Sayako Takeuchi, Yuki Kotani, Toshihide Tsujimoto
In the elderly, calcium-channel blockers are the first-line treatment for hypertension, and macrolides are commonly prescribed antibiotics. Here we report a 78-year-old man taking nifedipine, diltiazem and carvedilol who presented with persistent hypotension and bradycardia after clarithromycin was prescribed. He was diagnosed with drug-induced hypotension and treated with fluid resuscitation and vasoactive agents. His symptoms gradually improved. He was transferred out of the intensive care unit 3 days after hospitalisation...
January 9, 2017: BMJ Case Reports
Joana Faleiro Oliveira, Susana Rebelo Pacheco, Marta Moniz, Pedro Nunes, Clara Abadesso, Mónica Rebelo, Helena Loureiro, Helena Almeida
Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically. TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy. This case report describes an uncommon presentation of myocardial stunning after an anesthetic procedure. A 14-year-old girl with a history of pineal cyst and hemiplegic migraine was admitted for control brain magnetic resonance imaging...
June 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Matthew A Roberts, Helen L Pilmore, Francesco L Ierino, Sunil V Badve, Alan Cass, Amit X Garg, Nicole M Isbel, Henry Krum, Elaine M Pascoe, Vlado Perkovic, Anish Scaria, Andrew M Tonkin, Liza A Vergara, Carmel M Hawley
BACKGROUND: β-Blocking agents reduce cardiovascular mortality in patients with heart disease, but their potential benefit in dialysis patients is unclear. We aimed to determine the feasibility of a randomized controlled trial (RCT). STUDY DESIGN: Pilot RCT. SETTING & PARTICIPANTS: Patients who received dialysis for 3 or more months and were 50 years or older (or ≥18 years with diabetes or cardiovascular disease) were recruited from 11 sites in Australia and New Zealand...
June 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Anastasios Lymperopoulos, Katie A McCrink, Ava Brill
Carvedilol and metoprolol are two of the most commonly prescribed β-blockers in cardiovascular medicine and primarily used in the treatment of hypertension and heart failure. Cytochrome P450 2D6 (CYP2D6) is the predominant metabolizing enzyme of these two drugs. Since the first description of a CYP2D6 sparteinedebrisoquine polymorphism in the mid-seventies, substantial genetic heterogeneity has been reported in the human CYP2D6 gene, with ~100 different polymorphisms identified to date. Some of these polymorphisms render the enzyme completely inactive while others do not modify its activity...
2015: Current Drug Metabolism
Jingqun Zhang, Qiang Zhou, Chris D Smith, Haiyan Chen, Zhen Tan, Biyi Chen, Alma Nani, Guogen Wu, Long-Sheng Song, Michael Fill, Thomas G Back, S R Wayne Chen
Carvedilol is the current β-blocker of choice for suppressing ventricular tachyarrhythmia (VT). However, carvedilol's benefits are dose-limited, attributable to its potent β-blocking activity that can lead to bradycardia and hypotension. The clinically used carvedilol is a racemic mixture of β-blocking S-carvedilol and non-β-blocking R-carvedilol. We recently reported that novel non-β-blocking carvedilol analogues are effective in suppressing arrhythmogenic Ca(2+) waves and stress-induced VT without causing bradycardia...
September 1, 2015: Biochemical Journal
Gavin W K Wong, Alexandra Laugerotte, James M Wright
BACKGROUND: Drugs with combined alpha and beta blocking activity are commonly prescribed to treat hypertension. However, the blood pressure (BP) lowering efficacy of this class of beta blockers has not been systematically reviewed and quantified. OBJECTIVES: To quantify the dose-related effects of various types of dual alpha and beta adrenergic receptor blockers (dual receptor blockers) on systolic and diastolic blood pressure versus placebo in patients with primary hypertension...
August 26, 2015: Cochrane Database of Systematic Reviews
Takeru Nabeta, Takayuki Inomata, Yuichiro Iida, Yuki Ikeda, Miwa Iwamoto-Ishida, Shunsuke Ishii, Takashi Naruke, Tomohiro Mizutani, Hisahito Shinagawa, Toshimi Koitabashi, Ichiro Takeuchi, Junya Ako
Clinical practice guidelines emphasize that optimal pharmacotherapy, including beta-blockers (BB), is a prerequisite before receiving cardiac resynchronization therapy (CRT) in eligible patients with heart failure (HF). However, the optimal dose of BB before CRT implantation cannot be tolerated in a number of patients. Sixty-three consecutive patients who underwent CRT in 2006-2013 were retrospectively investigated. Before receiving CRT, BB could not be introduced in 20 patients (32 %); the daily carvedilol-equivalent dose in other 43 patients was 5...
July 2016: Heart and Vessels
Kristian Eskesen, Niels Thue Olsen, Veronica L Dimaano, Thomas Fritz-Hansen, Peter Sogaard, Theodore P Abraham
BACKGROUND: Beta-blockade is contraindicated in severe aortic regurgitation (AR) due to the fear of prolonging diastole and thus aggravate regurgitation. However, this has never been scientifically proven and positive effects of targeting the sympathetic system in AR has been demonstrated in several studies. METHOD: Thirty-nine Sprague-Dawley rats with AR were randomized to ten weeks of medical treatment with carvedilol or no treatment. Treatment was initiated either early or late after AR induction...
2015: SpringerPlus
Luigi Di Serafino, Francesco Luigi Rotolo, Augusto Boggi, Riccardo Colantonio, Roberto Serdoz, Francesco Monti
A 51-year-old male patient presented to the emergency room with an anterior ST-elevation myocardial infarction. After a loading dose of both ticagrelor and aspirin, the patient underwent primary-PCI on the left anterior descending coronary artery with stent implantation. After successful revascularization, medical therapy included beta-blockers, statins, and angiotensin II receptor antagonists. Two days later, ivabradine was also administered in order to reduce heart rate at target, but the patient developed a severe symptomatic bradycardia and sinus arrest, even requiring administration of both atropine and adrenaline...
2014: Case Reports in Cardiology
Piotr Kukla, Adrian Baranchuk, Marek Jastrzębski, Leszek Bryniarski, Rafał Baranowski
We describe a case of an 85-year-old woman admitted to hospital because of syncope with palpitations. The patient had mistakenly taken sotalol 120 mg/d together with carvedilol 6.25 mg/d. On hospital admission, ECG showed sinus bradycardia 52 bpm with marked QT prolongation: QTc presented variability from beat to beat (840 ms - 640 ms - 820 ms - 640 ms, respectively) with associated macro-alternans of T wave. T wave alternans was observed within the ascending portion of negative T wave. Beside it a J wave was seen...
2013: Kardiologia Polska
Jaekyu Shin, Mark J Pletcher
BACKGROUND: Large randomized trials have reported mixed results regarding the risk of bradycardia between metoprolol and carvedilol. We compared the incidence of emergent bradycardia (measured by an emergency department visit or hospitalization due to bradycardia) for patients initiating metoprolol and carvedilol. METHODS: Adult beneficiaries of Medi-Cal, the State of California Medicaid program, without a diagnosis of bradycardia who initiated metoprolol or carvedilol between May 1, 2004, and November 1, 2009, were included...
September 2013: American Journal of Medicine
Radka Kockova, Jarmila Svatunkova, Jiri Novotny, Lucie Hejnova, Bohuslav Ostadal, David Sedmera
A significant increase in cardiovascular medication use during pregnancy occurred in recent years. Only limited evidence on safety profiles is available, and little is known about the mechanisms of adverse effect on the fetus. We hypothesized that drug-induced bradycardia is the leading mechanism of developmental toxicity. Embryotoxicity was tested in ovo after administration of various doses of metoprolol, carvedilol, or ivabradine. Embryonic day (ED) 4 and 8 chick embryos were studied by video microscopy and ultrasound biomicroscopy ex ovo after intraamniotic injection of the drug for a period of 30 min...
March 15, 2013: American Journal of Physiology. Heart and Circulatory Physiology
H T Ong, L M Ong, F P Kow
Beta-blockers are underutilised in heart failure because clinicians may be unsure whether all beta-blockers are useful, how therapy should be initiated and whether beta-blockers are contraindicated in some patients. Bisoprolol, carvedilol and metoprolol succinate have been clearly proven to reduce mortality and hospitalisation in patients with Class II to IV heart failure; limited evidence also support short-acting metoprolol tartrate and nebivolol. Initiating dose should be very low (1.25 mg bisoprolol, 3...
February 2012: Medical Journal of Malaysia
Mona Fiuzat, Daniel Wojdyla, Dalane Kitzman, Jerome Fleg, Steven J Keteyian, William E Kraus, Ileana L Piña, David Whellan, Christopher M O'Connor
OBJECTIVES: This study sought to examine the association between baseline beta-blocker (BB) dose and outcomes in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial. BACKGROUND: Beta-blockers reduce morbidity and mortality in chronic heart failure (HF) patients with reduced ejection fraction, but it is unclear whether titrating to higher BB doses improves outcomes in this setting. METHODS: The HF-ACTION trial was a randomized, multicenter trial enrolling 2,331 ambulatory HF patients with systolic dysfunction (New York Heart Association functional class II to IV, left ventricular ejection fraction <0...
July 17, 2012: Journal of the American College of Cardiology
Mitja Lainscak, Matej Podbregar, Dragan Kovacic, Janez Rozman, Stephan von Haehling
BACKGROUND: Chronic obstructive pulmonary disease (COPD) frequently coexists in patients with chronic heart failure (CHF) and is a key factor for beta blocker underprescription and underdosing. This study compared effects of bisoprolol and carvedilol in patients with both conditions. METHODS: This was a randomized open-label study, of bisoprolol and carvedilol during initiation and uptitration to target or maximal tolerated dose. Pulmonary function testing, 12-lead electrocardiogram, and N-terminal pro brain natriuretic peptide were measured at baseline and follow-up...
October 2011: Respiratory Medicine
Nicoletta Riva, Gregory Y H Lip
INTRODUCTION: Heart failure (HF) is a common and disabling disease with a high prevalence in the elderly. Beta-blockers are among the mainstay therapies of HF because they antagonize the deleterious effects of the chronic activation of sympathetic nervous system. In large randomized clinical trials, bisoprolol, carvedilol and metoprolol reduced mortality and cardiovascular hospital admission and, hence, are included in current guidelines for HF treatment. AREAS COVERED: Nebivolol is a third-generation β-blocker with high selectivity for β1-adrenoceptors selectivity and vasodilating effects...
December 2011: Expert Opinion on Investigational Drugs
Yoshihiro Mori, Yasuhiro Nishikawa, Tomoko Iizuka, Natsuko Zenimura, Takuyuki Matsumoto, Katsutoshi Hiramatsu, Masahiro Komiya
BACKGROUND: In Japan, when pharmaceutical companies launch a new drug, they are obligated to conduct a post-marketing survey to evaluate the safety and efficacy of the drug in accordance with Good Post-Marketing Surveillance Practice under Article 14.4 (re-examination) of the Pharmaceutical Affairs Law at contracted medical institutions. We report the results of a drug use survey, which we conducted as a post-marketing survey. OBJECTIVE: This prospective post-marketing drug use survey was conducted to assess the safety and efficacy of the β-adrenergic receptor antagonist (β-blocker) Artist® Tablets (carvedilol) in patients with hypertension in Japan...
2011: Drugs in R&D
Allison S Dery, Leslie A Hamilton, Jessica A Starr
PURPOSE. The pharmacology, pharmacokinetics, efficacy, safety, and place in therapy of nebivolol are reviewed. SUMMARY. Nebivolol, a third-generation, highly β(1)-specific β-blocker, is labeled for the treatment of hypertension in the United States. In addition to its β-blocking effects, nebivolol has been shown to increase endothelin-dependent nitric oxide, giving it a unique peripheral vasodilatory action. Nebivolol is extensively metabolized by cytochrome P-450 isoenzyme 2D6. In patients with heart failure, certain β-blockers antagonize excessive adrenergic stimulation and can slow the progression of the disease...
May 15, 2011: American Journal of Health-system Pharmacy: AJHP
Hans-Dirk Düngen, Svetlana Apostolovic, Simone Inkrot, Elvis Tahirovic, Agnieszka Töpper, Felix Mehrhof, Christiane Prettin, Biljana Putnikovic, Aleksandar N Neskovic, Mirjana Krotin, Dejan Sakac, Mitja Lainscak, Frank Edelmann, Rolf Wachter, Thomas Rau, Thomas Eschenhagen, Wolfram Doehner, Stefan D Anker, Finn Waagstein, Christoph Herrmann-Lingen, Goetz Gelbrich, Rainer Dietz
AIMS: Various beta-blockers with distinct pharmacological profiles are approved in heart failure, yet they remain underused and underdosed. Although potentially of major public health importance, whether one agent is superior in terms of tolerability and optimal dosing has not been investigated. The aim of this study was therefore to compare the tolerability and clinical effects of two proven beta-blockers in elderly patients with heart failure. METHODS AND RESULTS: We performed a double-blind superiority trial of bisoprolol vs...
June 2011: European Journal of Heart Failure
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