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Titolo:
Cardiovascular adverse drug reaction associated with combined beta-adrenergic and calcium entry-blocking agents
Autore:
Edoute, Y; Nagachandran, P; Svirski, B; Ben-Ami, H;
Indirizzi:
Rambam Med Ctr, Dept Internal Med C, IL-31096 Haifa, Israel Rambam Med Ctr Haifa Israel IL-31096 ernal Med C, IL-31096 Haifa, Israel Technion Israel Inst Technol, Bruce Rappaport Fac Med, IL-31096 Haifa, Israel Technion Israel Inst Technol Haifa Israel IL-31096 L-31096 Haifa, Israel
Titolo Testata:
JOURNAL OF CARDIOVASCULAR PHARMACOLOGY
fascicolo: 4, volume: 35, anno: 2000,
pagine: 556 - 559
SICI:
0160-2446(200004)35:4<556:CADRAW>2.0.ZU;2-O
Fonte:
ISI
Lingua:
ENG
Soggetto:
CHRONIC STABLE ANGINA; COMBINATION THERAPY; PROPRANOLOL THERAPY; CARDIOGENIC-SHOCK; CAUTIONARY TALE; ORAL DILTIAZEM; DOUBLE-BLIND; PECTORIS; VERAPAMIL; BLOCKERS;
Keywords:
adverse drug effects; bradyarrhythmia; calcium antagonise; beta-adrenergic blocker;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Ben-Ami, H Rambam Med Ctr, Dept Internal Med C, POB 9602, IL-31096 Haifa, Israel Rambam Med Ctr POB 9602 Haifa Israel IL-31096 96 Haifa, Israel
Citazione:
Y. Edoute et al., "Cardiovascular adverse drug reaction associated with combined beta-adrenergic and calcium entry-blocking agents", J CARDIO PH, 35(4), 2000, pp. 556-559

Abstract

Numerous studies have shown a beneficial effect of combination therapy with beta-blockers and calcium antagonists in patients with anginal syndrome and/or hypertension. However, because both agents exert a negative chronotropic effect, their combined use may cause bradyarrhythmias with resultant symptoms of cerebral, coronary, and systemic hypoperfusion. We describe our clinical experience with patients who had cardiovascular adverse drug reactions (CVADRs) with combination therapy. This prospective study included 26 patients who had CVADRs among 2,574 admissions during a 2-year period. The study group included 14 men and 12 women with a median age of 73 years. Various combinations of calcium antagonists and beta-blockers were associated with the CVADRs. The most frequent pharmacologic combination was diltiazem plus propranolol. The CVADRs were the cause for hospital admission in 10 patients, an associated cause in nine patients, and developed during hospitalization in seven patients. Cardiac bradyarrhythmias were found in 22 patients. These rhythm abnormalities resolved within 24 h after discontinuation ofthe offending drugs. Temporary transvenous pacemaker insertion was necessary in only one patient with complete atrioventricular block. Twenty-two patients recovered, two patients died of pump failure not associated with CVADRs, and in two patients, the CVADRs contributed to the patients' death. CVADRs an not uncommon in elderly patients with ischemic heart disease and/ orhypertension treated with the concomitant use of calcium antagonist and beta-adrenergic blocking drugs. Use of calcium antagonist plus beta-blocker may unpredictably cause serious hemodynamic events, marked suppression of sinus node activity, and prolongation of atrioventricular conduction in some patients. Enhanced therapeutic monitoring may be warranted when calcium antagonists are combined with beta-blockers.

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Documento generato il 18/01/20 alle ore 07:42:35