Hemodynamic consequences of combined beta-adrenergic and slow calcium channel blockade in man

M. Packer, J. Meller, N. Medina, M. Yushak, H. Smith, J. Holt, J. Guererro, G. D. Todd, R. G. McAllister, R. Gorlin

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Abstract

The administration of verapamil to patients receiving β-adrenergic blocking drugs is reported to produce adverse circulatory reactions, but a systematic investigation of this potential drug interaction has not been performed in man. We administered 40-, 80- and 120-mg doses of verapamil orally to 15 patients with angina pectoris who were receiving high doses of propranolol or metoprolol. Verapamil produced dose-dependent decreases in cardiac performance: with 120 mg, cardiac index decreased by 0.38 l/min/m2, stroke volume index decreased by 2.8 ml/beat/m2 and heart rate decreased by 6 beats/min, associated with increases in pulmonary capillary wedge (2.2 mm Hg) and mean right atrial pressures (1.7 mm Hg) (all p <0.01); two patients had marked, but asymptomatic, hypotensive reactions. In contrast, repeat administration of 120-mg doses of verapamil 24-30 hours after withdrawal of β blockade produced no significant cardiodepressant effects despite significantly higher plasma levels of verapamil than during propranolol therapy (383.1 vs 205.1 ng/ml, p <0.01). In conclusion, verapamil produces significant negative inotropic and chronotropic effects in patients treated with β-adrenergic antagonists; combination therapy should therefore be used with caution in patients with angina pectoris.

Original languageEnglish (US)
Pages (from-to)660-668
Number of pages9
JournalUnknown Journal
Volume65
Issue number4
DOIs
StatePublished - Jan 1 1982

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Packer, M., Meller, J., Medina, N., Yushak, M., Smith, H., Holt, J., Guererro, J., Todd, G. D., McAllister, R. G., & Gorlin, R. (1982). Hemodynamic consequences of combined beta-adrenergic and slow calcium channel blockade in man. Unknown Journal, 65(4), 660-668. https://doi.org/10.1161/01.CIR.65.4.660