Search

While cyclandelate is widely used in the therapy of peripheral arterial disease, objective evidence of its efficacy remains controversial. For this reason, 12 patients with intermittent claudication (average age of 66.8 years) received both cyclandelate 400 mg qid and placebo in a double-blind crossover trial lasting two months. During the cyclandelate and placebo periods, the following peripheral hemodynamic measurements were obtained using a plethysmograph and treadmill claudication testing: mean calf blood flow, vascular resistance and venous capacitance; finger and toe blood flow, pulsation amplitude and temperature before and after vasodilating maneuvers; arm and leg arterial pulsation amplitudes, one and ten minute calf reactive hyperemia reaction; 30 pound/30 second calf active hyperemia reactions and times of onset of claudication as measured on a treadmill. No major significant difference could be demonstrated between placebo and cyclandelate on any subjective symptom or any objective measurement. It is concluded that cyclandelate 400 mg qid for 4 weeks was of little objective value in treating this group of 12 patients with peripheral arterial disease and suffering from intermittent claudication. [ABSTRACT FROM AUTHOR]

The unloading mechanisms and site of peripheral action of the new antianginal drug molsidomine was compared with isosorbide dinitrate (ISDN) in 14 patients with acute myocardial infarction using a Swan-Ganz catheter and venous occlusion plethysmography. Sublingual molsidornine (2-4 mg) increased calf venous capacitance (CVC) (0.42 ± 0.18 to 0.64 ± 0.09 ml/100 ml, p < 0.05) from 30 to 240 minutes, while simultaneously lowering of PCWP (25.9 ± 4.9 to 15.8 ± 7.3 mmHg, p < 0.05) and CVP (9.3 ± 3.7 to 5.8 ± 3.5 cmH2O, p < 0.05). Calf blood flow (CBF), calf vascular resistance (CVR), CI, TSPR and SWI were not affected significantly. Molsidomine reduced preload more than 240 minutes after its administration. Sublingual ISDN increased CBF into the initial IS minutes (1.19 ± 0.49 to 1.83 ± 0.98 mI/100mI/min, p < 0.05) and CVC from 5 to 60 minutes (0.42 ± 0.19 to 0.68 ± 0.24 ml/100ml p < 0.01) while simultaneously lowering PCWP (24.3 ± 2.2 to 14.6 ± 4.5 mmHg, p < 0.01) and CVP (9.0 ± 2.8 to 5.5 ± 3.5 cmH2O, p < 0.05). Neither drug affected cardiac index, blood pressure or systemic vascular resistance. These data suggest that molsidomine significantly lowered elevated preload (PCWP/CVP) by dilating venous capacitance vessels. Its length of action was 240 minutes compared with 60 minutes obtained with ISDN, which suggests this new agent may be of marked benefit in the AMI patients suffering from backward failure uncomplicated by forward failure in whom continued preload reduction is necessary. (Results are expressed as the mean ± standard deviation). [ABSTRACT FROM AUTHOR]

A double-blind, placebo-controlled, parallel groups study design was utilized to evaluate the efficacy and the safety of papaverine HCL (PA, 300-1,500 mg/day) in the treatment of intermittent claudication. The study was in two phases: Phase 1-6 weeks duration with treadmill claudication tests and doppler ankle/brachial pressure studies every 2 weeks to establish disease stability; Phase 11-12 weeks double-blind evaluation of PA versus placebo (PL) with treadmill claudication tests and doppler ankle/brachial pressure studies every 4 weeks. Intermittent claudication was documented by symptoms, history and objective evidence of decreased blood supply to the lower extremities: decreased resting and post-exercise ankle/brachial pressure indices (A/B Pr), diminished segmental pulse-volumes and physical findings. Data were collected to determine the distance to initial pain (IP), rapidly increasing pain (RIP) and absolute claudication (AC) during treadmill tests and also the changes in resting and post-exercise A/B Pr. In 20 patients who completed this study, the distance to RIP was increased 43% by PA and decreased 2% by PL (p=0.012). PA increased the distance to AC by 29%, but was decreased by 1% in PL (p=0.039). The A/B Pr studies showed significant less decrease in 1 minute and 2.5 minutes post exercise A/B Pr at 12 weeks in PA patients as compared to those in PL patients. Compared to PL, significantly greater increases in the key measurements of exercise performance and less decreases in post exercise A/B Pr were developed by the peripheral vasodilator, papaverine HCL. These results indicate that papaverine HCL is a safe and useful adjunct in the medial treatment of peripheral arterial insufficiency. [ABSTRACT FROM AUTHOR]