-
Medicine Jan 2021Since 2008, oral propranolol has evolved as the first-line therapy for infantile hemangiomas (IHs). Meanwhile, oral atenolol gradually shows comparative effectiveness...
Since 2008, oral propranolol has evolved as the first-line therapy for infantile hemangiomas (IHs). Meanwhile, oral atenolol gradually shows comparative effectiveness versus oral propranolol with few side effects. Here, we conducted a mobile internal survey among a group of Chinese clinicians about how they choose the dosage, dose regimen, and dose escalation methods of propranolol and atenolol for the treatment of IH.A mobile-ready internal survey on the application of oral propranolol and oral atenolol for IH in mainland China was performed and distributed to 333 potential clinicians from different levels of healthcare institutions in mainland China. Eighty-one doctors responded to the survey. All the respondents had the experience of treating IH with oral propranolol and 32 had the experience with oral atenolol.Most of the doctors from tertiary hospitals chose 2 mg/kg/d twice daily, while most of those with the experience of propranolol from private hospitals chose 1 mg/kg/d once daily. More doctors from tertiary hospitals had the experience of atenolol than those from private hospitals.Oral atenolol has become another medication intervention option for IH in mainland China. This survey is helpful to standardize and develop a guideline of oral atenolol therapy for IH.
Topics: Administration, Oral; Antihypertensive Agents; Atenolol; China; Female; Hemangioma; Humans; Infant; Male; Propranolol; Surveys and Questionnaires; Treatment Outcome
PubMed: 33429792
DOI: 10.1097/MD.0000000000024146 -
The Journal of Physiology Jul 2019We investigated the cardiovascular and respiratory responses of the normotensive Wistar-Kyoto (WKY) rat and the spontaneously hypertensive (SH) rat to inhalation and...
KEY POINTS
We investigated the cardiovascular and respiratory responses of the normotensive Wistar-Kyoto (WKY) rat and the spontaneously hypertensive (SH) rat to inhalation and intravenous injection of the noxious stimuli allyl isothiocyanate (AITC). AITC inhalation evoked atropine-sensitive bradycardia in conscious WKY rats, and evoked atropine-sensitive bradycardia and atenolol-sensitive tachycardia with premature ventricular contractions (PVCs) in conscious SH rats. Intravenous injection of AITC evoked bradycardia but no tachycardia/PVCs in conscious SHs, while inhalation and injection of AITC caused similar bradypnoea in conscious SH and WKY rats. Anaesthesia (inhaled isoflurane) inhibited the cardiac reflexes evoked by inhaled AITC but not injected AITC. Data indicate the presence of a de novo nociceptive pulmonary-cardiac reflex triggering sympathoexcitation in SH rats, and this reflex is dependent on vagal afferents but is not due to steady state blood pressure or due to remodelling of vagal efferent function.
ABSTRACT
Inhalation of noxious irritants/pollutants activates airway nociceptive afferents resulting in reflex bradycardia in healthy animals. Nevertheless, noxious pollutants evoke sympathoexcitation (tachycardia, hypertension) in cardiovascular disease patients. We hypothesize that cardiovascular disease alters nociceptive pulmonary-cardiac reflexes. Here, we studied reflex responses to irritants in normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive (SH) rats. Inhaled allyl isothiocyanate (AITC) evoked atropine-sensitive bradycardia with atrial-ventricular (AV) block in conscious WKY rats, thus indicating a parasympathetic reflex. Conversely, inhaled AITC in conscious SH rats evoked complex brady-tachycardia with both AV block and premature ventricular contractions (PVCs). Atropine abolished the bradycardia and AV block, but the atropine-insensitive tachycardia and PVCs were abolished by the β -adrenoceptor antagonist atenolol. The aberrant AITC-evoked reflex in SH rats was not reduced by acute blood pressure reduction by captopril. Surprisingly, intravenous AITC only evoked bradycardia in conscious SH and WKY rats. Furthermore, anaesthesia reduced the cardiac reflexes evoked by inhaled but not injected AITC. Nevertheless, anaesthesia had little effect on AITC-evoked respiratory reflexes. Such data suggest distinct differences in nociceptive reflex pathways dependent on cardiovascular disease, administration route and downstream effector. AITC-evoked tachycardia in decerebrate SH rats was abolished by vagotomy. Finally, there was no difference in the cardiac responses of WKY and SH rats to vagal efferent electrical stimulation. Our data suggest that AITC inhalation in SH rats evokes de novo adrenergic reflexes following vagal afferent activation. This aberrant reflex is independent of steady state hypertension and is not evoked by intravenous AITC. We conclude that pre-existing hypertension aberrantly shifts nociceptive pulmonary-cardiac reflexes towards sympathoexcitation.
Topics: Animals; Blood Pressure; Bradycardia; Captopril; Heart; Heart Rate; Hypertension; Isothiocyanates; Lung; Male; Nociceptors; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Reflex; Tachycardia; Vagus Nerve
PubMed: 31077371
DOI: 10.1113/JP278085 -
JAMA May 2015An 87-year-old female with a history of open-angle glaucoma presented with longer, thicker eyelashes on the right side compared to the left. Her irides were also...
An 87-year-old female with a history of open-angle glaucoma presented with longer, thicker eyelashes on the right side compared to the left. Her irides were also different colors, as the right iris was brown and the left was hazel (green-brown). The patient had noticed a gradual darkening of her right iris and lengthening of her eyelashes over the last year, but denied visual changes or foreign-body sensation. Past medical history included a remote history of breast cancer treated by lumpectomy and radiation therapy, cerebrovascular accident, hypercholesterolemia, and hypertension. Her medications included bimatoprost, atenolol, atorvastatin, and clopidogrel.
Topics: Aged, 80 and over; Amides; Bimatoprost; Cloprostenol; Eyelashes; Female; Glaucoma, Open-Angle; Humans; Hypertrichosis; Iris Diseases; Pigmentation Disorders
PubMed: 25988467
DOI: 10.1001/jama.2015.1348 -
Clinical Pharmacology : Advances and... 2017Apixaban is often coadministered with treatments for cardiovascular comorbidities, which may lead to unintended drug-drug interactions (DDIs). The effects of apixaban on...
PURPOSE
Apixaban is often coadministered with treatments for cardiovascular comorbidities, which may lead to unintended drug-drug interactions (DDIs). The effects of apixaban on pharmacokinetics (PK) of multidose Lanoxin (digoxin) and single-dose Tenormin (atenolol) and the effects of single-dose atenolol on apixaban PK in healthy subjects were investigated in two Phase 1 studies.
PATIENTS AND METHODS
The digoxin DDI study was an open-label, multidose, two-treatment, single-sequence study in which subjects received digoxin 0.25 mg q6h on day 1, then once daily on days 2-10, followed by apixaban 20 mg and digoxin 0.25 mg once daily on days 11-20. The atenolol DDI study was an open-label, single-dose, randomized, three-period, three-treatment, crossover study in which subjects received a single oral dose of apixaban 10 mg, atenolol 100 mg, or apixaban 10 mg plus atenolol 100 mg. The 90% confidence intervals (CIs) for the ratios of geometric means of peak plasma concentration (C) and area under the concentration-time curve (AUC), with and without apixaban were calculated. Absence of effect was concluded if the point estimates and 90% CI were within the equivalence interval of 80%-125% (digoxin) or 70%-143% (atenolol). A similar analysis was performed to assess the effect of atenolol on apixaban.
RESULTS
Apixaban had no clinically relevant effect on the PK of either atenolol or digoxin: point estimates and 90% CI for both digoxin and atenolol C and AUC were entirely within their respective no-effect intervals. Apixaban C and AUC were slightly decreased (ie, 18% and 15% lower, respectively) following atenolol coadministration. No serious or major bleeding-related adverse events were reported during either study.
CONCLUSION
Apixaban had no effect on the PK of digoxin and there was no clinically relevant interaction between apixaban and atenolol. Coadministration of digoxin or atenolol with apixaban in healthy subjects was generally well tolerated.
PubMed: 28260951
DOI: 10.2147/CPAA.S115687 -
Circulation Journal : Official Journal... Mar 2023α/β- and β-blockers are essential in pregnant women's perinatal congenital heart disease management. Nevertheless, data on the effects of α/β- and β-blockers on...
BACKGROUND
α/β- and β-blockers are essential in pregnant women's perinatal congenital heart disease management. Nevertheless, data on the effects of α/β- and β-blockers on pregnant women and fetuses are limited. We examined the risks of neonatal hypoglycemia and small for gestational age (SGA) associated with maternal exposure to α/β- and β-blockers.Methods and Results: All consecutive pregnant women with heart disease admitted to our hospital between January 2014 and October 2020 were included. Of 306 pregnancies (267 women), 32 were in the α/β-blocker group, 11 were in the β-blocker group, and 263 were in the control group. All 32 pregnancies in the α/β-blocker group were treated with carvedilol. In the β-blocker group, 4 women were treated with bisoprolol, 3 were treated with propranolol, 2 were treated with atenolol, 1 was treated with metoprolol, and 1 was treated nadolol. The incidence of neonatal hypoglycemia was higher in pregnant women taking carvedilol than in the control group (P=0.025). SGA was observed significantly more frequently in pregnant women taking β-blockers than in the carvedilol and control groups (P<0.001).
CONCLUSIONS
Carvedilol administration during pregnancy was associated with neonatal hypoglycemia; however, it did not occur in a time- or dose-dependent manner. Routine monitoring of blood glucose levels in newborns exposed to α/β- and β-blockers is essential.
Topics: Female; Infant, Newborn; Humans; Pregnancy; Carvedilol; Gestational Age; Adrenergic beta-Antagonists; Metoprolol; Hypoglycemia
PubMed: 36823100
DOI: 10.1253/circj.CJ-22-0647 -
Journal of Clinical Hypertension... Oct 2018A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β-blockers to assess knowledge and use of this... (Comparative Study)
Comparative Study
A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β-blockers to assess knowledge and use of this heterogeneous drug class for hypertension. More cardiologists than PCPs chose β-blockers as initial antihypertensive therapy (30% vs 17%, P < 0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. Cardiologists rated "impact on energy" and "arterial vasodilation" as more important than PCPs (P < 0.05/<0.01, respectively). Awareness of vasodilation was greater for carvedilol (52%) than nebivolol (31%). Association between β-blockers and clinical variables included nebivolol with β -selectivity, nebivolol and carvedilol with vasodilation and efficacy in older patients and African Americans, metoprolol with heart rate reduction, and atenolol and metoprolol with weight gain and hyperglycemia. Physicians preferred prescribing β-blockers with lower risk of incident diabetes. Clinical practice guidelines influenced physician prescribing more than formularies or performance metrics. This survey captures physicians' perceptions/use of various β-blockers and clinically relevant knowledge gaps.
Topics: Adrenergic beta-Antagonists; Black or African American; Aged; Aged, 80 and over; Antihypertensive Agents; Atenolol; Cardiologists; Carvedilol; Heart Rate; Humans; Hypertension; Metoprolol; Nebivolol; Perception; Physicians, Primary Care; Practice Guidelines as Topic; Surveys and Questionnaires; Vasodilation
PubMed: 30289609
DOI: 10.1111/jch.13375 -
Sorption and biodegradation parameters of selected pharmaceuticals in laboratory column experiments.Journal of Contaminant Hydrology Jan 2021Pharmaceutically active compounds have increasingly been detected in groundwater worldwide. Despite constituting a risk for human health and ecosystems, their fate in...
Pharmaceutically active compounds have increasingly been detected in groundwater worldwide. Despite constituting a risk for human health and ecosystems, their fate in the environment has still not been exhaustively investigated. This study characterizes the transport behavior of five selected pharmaceutically active compounds (antipyrine, atenolol, caffeine, carbamazepine and sulfamethoxazole) in two sediments (coarse quartz sand and sandy loam) using column experiments with long-term injection of spiked groundwater. Transport parameters were estimated using an analytical reactive transport model. When five selected compounds were injected simultaneously, transport behavior of antipyrine, carbamazepine and the antibiotic sulfamethoxazole were similar to the conservative tracer in both sediments and under varying redox conditions. Atenolol and caffeine were retarded significantly stronger in the sandy loam sediment than in the coarse quartz sand. Biodegradation of caffeine was observed in both sediments after an adaption period and depended on dissolved oxygen. The identification of biodegradation processes was supported by monitoring of intracellular adenosine triphosphate (ATP) as a measure for microbial activity. ATP was present in varying concentrations in all sediments and was highest when biodegradation of pharmaceuticals, especially caffeine, was observed. When only caffeine and sulfamethoxazole were injected simultaneously, sulfamethoxazole was degraded while caffeine degradation was reduced. The latter seemed to be influenced by low concentrations in dissolved oxygen rather than the presence of the antibiotic sulfamethoxazole. Results of these experiments emphasize the impact on pharmaceutical sorption and (bio)degradation of sediment type and redox conditions, as well as available time for microbial adaption and the combination of pharmaceuticals that are released together into groundwater.
Topics: Biodegradation, Environmental; Ecosystem; Humans; Laboratories; Pharmaceutical Preparations; Water Pollutants, Chemical
PubMed: 33310632
DOI: 10.1016/j.jconhyd.2020.103738 -
Biomolecules Aug 2022De novo sterol synthesis is a critical homeostatic mechanism in the brain that begins during early embryonic development and continues throughout life. Multiple...
De novo sterol synthesis is a critical homeostatic mechanism in the brain that begins during early embryonic development and continues throughout life. Multiple medications have sterol-biosynthesis-inhibiting side effects, with potentially detrimental effects on brain health. Using LC-MS/MS, we investigated the effects of six commonly used beta-blockers on brain sterol biosynthesis in vitro using cell lines. Two beta-blockers, metoprolol (MTP) and nebivolol, showed extreme elevations of the highly oxidizable cholesterol precursor 7-dehydrocholesterol (7-DHC) in vitro across multiple cell lines. We followed up on the MTP findings using a maternal exposure model in mice. We found that 7-DHC was significantly elevated in all maternal brain regions analyzed as well as in the heart, liver and brain of the maternally exposed offspring. Since DHCR7-inhibiting/7-DHC elevating compounds can be considered teratogens, these findings suggest that MTP utilization during pregnancy might be detrimental for the development of offspring, and alternative beta-blockers should be considered.
Topics: Animals; Brain; Cholesterol; Chromatography, Liquid; Female; Metoprolol; Mice; Nebivolol; Oxidoreductases Acting on CH-CH Group Donors; Pregnancy; Tandem Mass Spectrometry; Teratogens
PubMed: 36139049
DOI: 10.3390/biom12091211 -
Proceedings of the National Academy of... Oct 2019Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine...
Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine population-scale consumption of chemicals, particularly illicit drugs, across different communities and over time. However, the sociodemographic or socioeconomic correlates of chemical consumption and exposure are unclear. This study explores the relationships between catchment specific sociodemographic parameters and biomarkers in wastewater generated by the respective catchments. Domestic wastewater influent samples taken during the 2016 Australian census week were analyzed for a range of diet, drug, pharmaceutical, and lifestyle biomarkers. We present both linear and rank-order (i.e., Pearson and Spearman) correlations between loads of 42 biomarkers and census-derived metrics, index of relative socioeconomic advantage and disadvantage (IRSAD), median age, and 40 socioeconomic index for area (SEIFA) descriptors. Biomarkers of caffeine, citrus, and dietary fiber consumption had strong positive correlations with IRSAD, while tramadol, atenolol, and pregabalin had strong negative correlation with IRSAD. As expected, atenolol and hydrochlorothiazide correlated positively with median age. We also found specific SEIFA descriptors such as occupation and educational attainment correlating with each biomarker. Our study demonstrates that wastewater-based epidemiology can be used to study sociodemographic influences and disparities in chemical consumption.
Topics: Australia; Food Analysis; Humans; Pharmaceutical Preparations; Socioeconomic Factors; Wastewater; Wastewater-Based Epidemiological Monitoring
PubMed: 31591193
DOI: 10.1073/pnas.1910242116 -
Circulation Sep 2020
Topics: Atenolol; Blood Pressure; Female; Furosemide; Histoplasmosis; Humans; Hypertension, Pulmonary; Middle Aged
PubMed: 32986484
DOI: 10.1161/CIRCULATIONAHA.120.046428