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This work was aimed at clarifying whether the anti-depressant doxepin had a cardiodepressant action, or favoured or initiated arrhythmias and/or ventricular conduction disorders, when administered orally for 14 days at a daily dosage of 75 mg. Under doxepin therapy there was a slight increase in mean heart rate on effort in comparison to the placebo. This increase, which amounted to 2 to 6 beats per minute, was most marked among the younger patients, but had neither clinical nor statistical significance (cocaine-like effect of tricyclic psychotropic drugs). No significant changes of ECG, blood-pressure, x-ray determination of heart volume (by the method of Klepzig and Frisch), and maximum performance on the cycle ergometer were stated under doxepin therapy in comparison to the placebo. On the basis of these results it appears justified to state that administering oral doses of about 75 mg doxepin per day for moderately long periods produces no cardiotoxic side-effects.

The effect of the aldosterone-antagonist Spironolacton in decompensated hydropic cardiac insufficiency is explored with patients not re-compensated under a glycosid-diuretica-therapy. This analysis is based on the clinical records and other documents of 34 patients with most serious oedematous cardiac insufficiency of different genesis. For elucidation of the result of the clinical treatment two casuistic cases are described. The probability of mortality or survival-rate is calculated, periods of observation could be achieved up to more than nine years. It is endeavoured to compare the results with observations of patients-collectives, that are known from the literature. Statistically significant decreases in weight are objectified. When examining the reactions of blood-pressure at the Spironolacton-therapy no statistically significant alterations of blood-pressure could be observed with those cardiac-decompensated patients. 6.25 per cent of the considered serum-potassium-data were underneath the limitations of lower standard, at 1.875 per cent of the measured values a hyperkalemia existed. No clinical side-effects could be observed except the incidence of a gynaecomastia with two male patients. A protracted therapy with Spironolacton for patients with decompensated hydropical myocardial insufficiency is appropriated to support recompensation in addition to the hitherto conventional possibilities of therapy, and to maintain this achieved re-compensation.

In 15 patients with coronary heart disease and typical ST-segment depression during and/or after increasing physical effort in supine cycloergometry the normalizing effect of different dosages of Molsidomine on the electrocardiogram under effort was investigated in 74 exercise tolerance tests. Already after application of 0,5 mg Molsidomine there was observed a significant positive effect in comparison to an identical workload without drug. The normalizing effect was further increased by raising the dosage ot 1 mg or 2 mg respectively. To the administration of 3 mg only 1 out of 10 patients in the trial responded with an additional normalizing effect on the ECG since the rest of the patients showed already normal ECGs on 2 mg. This dose relationship also was observed in the pressure-rate-product. There was a dose-dependent decrease from which we can conclude a relief of the working myocardium. Under effort without drug 13 of 15 patients complained about stenocardia. Under the same effort and under Molsidomine however there were no more of these complaints. Because of these results it is recommended to use 2 mg of Molsidomine as a dosage in daily routine. It is needed 2 or 3 times dialy since in previous investigations there was shown a long-lasting effect over more than 5 hours. 3 out of 15 patients showed side effects which were only weak headache or weak congestion in the head.

A new agent, Molsidomine, with anti-anginal effect was investigated in 43 patients with coronary heart disease by means of 121 exercise tolerance studies. A good effect was observed 1 hour after sublingual or enteral absorption of 2 mg, which was comparable to 20 mg of Isosorbiddinitrate administered sublingually. Recorded and evaluated were the depression of ST-segment in the ECG, heart rate, systolic and diastolic blood pressure as well as subjective parameters. In comparison to the controls there was a highly significant reduction of anginal pain and ST-depression equivalent to that obtained 1 hour after Isosorbiddinitrate. The effect of Molsidomine could be established already 10 min after sublingual administration and sustained 5 to 6 hours afterwards with a highly statistic significance after sublingual as well as after enteral absorption. Side effects were noticed in 3 out of 43 patients, 2 of them with headache. The remarkable advantages of the drug are to be seen in its simple dosage and administration, its good tolerability, and its intrinsic retard-effect. A combination with beta-blocking agents seems to be possible in the same way as with Isosorbiddinitrate.