piperidines and clobutinol

Cloperastine is an antitussive drug, which can be received as an over-the-counter cold medicine. The chemical structure of cloperastine is quite similar to that of the antihistamine drug diphenhydramine, which is reported to inhibit hERG K⁺ channels and clinically induce long QT syndrome after overdose. To analyze its proarrhythmic potential, we compared effects of cloperastine and diphenhydramine on the hERG K⁺ channels expressed in HEK293 cells. We further assessed their effects on the halothane-anesthetized guinea-pig heart under the monitoring of monophasic action potential (MAP) of the ventricle. Cloperastine inhibited the hERG K⁺ currents in a concentration-dependent manner with an IC₅₀ value of 0.027 μM, whose potency was 100 times greater than that of diphenhydramine (IC₅₀; 2.7 μM). In the anesthetized guinea pigs, cloperastine at a therapeutic dose of 1 mg/kg prolonged the QT interval and MAP duration without affecting PR interval or QRS width. Diphenhydramine at a therapeutic dose of 10 mg/kg prolonged the QT interval and MAP duration together with increase in PR interval and QRS width. The present results suggest that cloperastine may be categorized as a QT-prolonging drug that possibly induces arrhythmia at overdoses like diphenhydramine does.

Topics: Action Potentials; Amino Alcohols; Animals; Animals, Inbred Strains; Anti-Arrhythmia Agents; Antitussive Agents; Diphenhydramine; Ether-A-Go-Go Potassium Channels; Guinea Pigs; Heart Ventricles; HEK293 Cells; Humans; Long QT Syndrome; Membrane Potentials; Osmolar Concentration; Patch-Clamp Techniques; Piperidines; Potassium Channel Blockers; Recombinant Proteins; Structure-Activity Relationship

Clobutinol has been clinically reported to induce long QT syndrome. To clarify its cardiac electrophysiological properties, we compared effects of clobutinol on the isolated myocardium and anesthetized guinea pig heart with those of a hERG K channel blocker, E-4031. In isolated guinea pig ventricular tissues, clobutinol (3 microM) as well as E-4031 (10-100 nM) prolonged the action potential duration without affecting maximum upstroke velocity, but no further prolongation was observed after application of 30 microM clobutinol. In anesthetized closed-chest guinea pigs, clobutinol (1 and 10 mg/kg, intravenously) and E-4031 (0.01 and 1 mg/kg, intravenously) prolonged the QT interval and duration of the monophasic action potential (MAP) in a dose-dependent manner and at the same time increased the beat-to-beat variability of the MAP duration and reversed use-dependent prolongation of the MAP duration and triangulation of the MAP configuration. These results suggest that clobutinol delayed the ventricular repolarization and increased the proarrhythmic parameters linked to the hERG K channel inhibitor-induced torsade de pointes arrhythmias.

Topics: Action Potentials; Amino Alcohols; Anesthesia; Animals; Antitussive Agents; Blood Pressure; Electric Stimulation; Electrocardiography; Electrophysiological Phenomena; ERG1 Potassium Channel; Ether-A-Go-Go Potassium Channels; Female; Guinea Pigs; Halothane; Heart; Heart Rate; Male; Membrane Potentials; Piperidines; Pyridines; Ventricular Function; Ventricular Function, Right

Intravenous administration of opioids, e.g. morphine and codeine, causes bronchoconstriction in animals and susceptible patients such as asthmatics. Therefore, the effects of two opioid antitussives (codeine and dextromethorphan), two non-opioid antitussives (vadocaine hydrochloride (2',4'-dimethyl-6'-methoxy-3-(2-methylpiperidyl) propionanilide hydrochloride, OR K-242-HCl; INN: vadocaine) and clobutinol), and lidocaine on basal lung mechanics and methacholine (MeCh, 6 micrograms/kg i.v.)-induced airway obstruction were investigated in anaesthetized guinea-pigs. Intravenous administration of codeine (10-20 mg/kg) produced a dual response in the airways; initial bronchoconstriction was followed by attenuation of the MeCh-response. Dextromethorphan (10 and 15 mg/kg) caused bronchoconstriction only. Both the opioids affected dynamic lung compliance (CDyn) more than lung resistance (RL). At doses between 1 and 20 mg/kg i.v., vadocaine, clobutinol, and lidocaine had no obvious effect on the airways. Dextromethorphan and vadocaine, both at doses of 10 and 15 mg/kg, and clobutinol (15 and 20 mg/kg) caused irreversible bradycardia and hypotension, whereas codeine (5-20 mg/kg) increased blood pressure, and to a lesser extent heart rate. These results suggest that intravenous administration of an opioid antitussive influences the small peripheral airways more than the large airways, whether the opioid has euphoric analgesic properties or not. In contrast to this, non-opioid antitussives such as vadocaine and clobutinol are without effect. At large doses, all antitussives influence the cardiovascular system considerably.

Topics: Amino Alcohols; Animals; Antitussive Agents; Blood Pressure; Female; Guinea Pigs; Heart Rate; Hemodynamics; Lidocaine; Lung; Methacholine Compounds; Piperidines; Respiratory Function Tests