dihydroergotoxine and Heart-Failure

Ibopamine has hemodynamic and neurohumoral effects potentially useful for the treatment of congestive heart failure (CHF), but its mechanism of action is not completely clear. To evaluate the role of dopaminergic receptor stimulation in the hemodynamic and neurohumoral activity of ibopamine, we compared the effects of ibopamine, 100 mg orally (p.o.) with those of the dopamine 2, 4, and 6 micrograms/kg/min intravenously (i.v.) and of the DA2 agonist dihydroergotoxine 6 micrograms/kg i.v. in 13 patients with chronic CHF [left ventricular ejection fraction (LVEF) < or = 35%]. All patients underwent right heart Swan-Ganz catheterization with determination of hemodynamic parameters at baseline, after 30 min of infusion of each dose of dopamine (DA) and < or = 6 h after ibopamine and dihydroergotoxine administration. Blood samples for the assessment of plasma renin activity (PRA), aldosterone, norepinephrine (NE), and epinephrine (Epi) were also obtained. Ibopamine induced a peak 21% increase of cardiac index (CI) with a 23 and 25% increase in stroke volume (SV) and stroke work indexes (SWI), respectively, and an 18% reduction in systemic vascular resistance (SVR). Similar changes were observed after DA infused at the doses of 2 and 4 micrograms/kg/min, whereas with the dose of 6 micrograms/kg/min heart rate (HR) increased by 23% and SV index (SVI) did not change further. Dihydroergotoxine administration induced only a significant 9% decrease in mean arterial pressure (MAP), with a 13% reduction in SVR.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Aged; Aldosterone; Analysis of Variance; Blood Pressure; Deoxyepinephrine; Dihydroergotoxine; Dopamine; Dopamine Agonists; Epinephrine; Heart Failure; Heart Rate; Humans; Injections, Intravenous; Male; Middle Aged; Norepinephrine; Radionuclide Imaging; Renin; Stroke Volume; Vascular Resistance

There is now evidence for the presence of a dopaminergic inhibitory modulation of aldosterone production that is mediated by D-2 receptors in the adrenal cortex. In this study we evaluated the effects of dopamine and the dopaminergic agonists ibopamine and dihydroergotoxine on aldosterone secretion and plasma renin activity in 13 patients with chronic heart failure. Two groups of patients were noted: one responding to dopaminergic drugs with a decrease in plasma aldosterone and the other without dopamine agonist-related aldosterone suppression. No effect on plasma renin activity was found after each drug administration. A correlation was found between the response to dopamine agonists and basal plasma aldosterone levels. These data are of therapeutic value in showing the detrimental effect of the activation of the renin-angiotensin-aldosterone system occurring in heart failure: a drug reducing this activation appears promising for both its acute and long-term effects.

Topics: Aged; Aldosterone; Deoxyepinephrine; Depression, Chemical; Dihydroergotoxine; Dopamine; Dopamine Agents; Heart Failure; Humans; Male; Middle Aged; Random Allocation; Renin; Renin-Angiotensin System

Topics: Acetyldigoxins; Aged; Clinical Trials as Topic; Digoxin; Dihydroergotoxine; Double-Blind Method; Drug Therapy, Combination; Female; Heart Failure; Humans; Male; Neurocognitive Disorders; Random Allocation

In a controlled double-blind trial in 80 patients with cerebrovascular and cardiac insufficiency the differentiated effect of a combination therapy with cardiac glycosides and Hydergin were studied both with regard to parameters of cerebral organic and cardiac performance. Two randomized collectives of patients with an average age of 63 years were compared with each other for this purpose. They received either acetyldigoxin (0.4 mg/day) alone or in combination with Hydergin (3 mg/day). Duration of treatment was 8 weeks altogether. The single treatment with the cardiac glycoside alone does not lead to a satisfactory improvement in the symptoms of cerebral attacks. The results presented of this study support the necessity in these patients of an internist basic therapy in combination with a preparation like Hydergin acting favorably on cerebral metabolism.

Topics: Acetyldigoxins; Cerebrovascular Disorders; Digoxin; Dihydroergotoxine; Double-Blind Method; Female; Heart Failure; Humans; Male; Middle Aged

Topics: Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Digoxin; Dihydroergotoxine; Drug Combinations; Female; Heart Failure; Humans; Male; Middle Aged

Topics: Acetyldigitoxins; Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Digitoxin; Dihydroergotoxine; Drug Combinations; Drug Evaluation; Female; Heart Failure; Humans; Male; Middle Aged

The adaptability of the kidney in heart-failure is restricted. This is due to a sympathetically mediated renal vasoconstriction, forming part of a sympathetically induced general rearrangement of haemodynamics. This is reflected in a rise of the total peripheral vascular resistance and of the right auricular pressure and can be normalized to a large extent by sympathetic gamma-blockade. The renal vasoconstriction reduces the glomerular filtration rate and, thus, the tubular sodium load. Simultaneously, possibly by the same sympathetic stimulus, more renin is liberated from the juxtaglomerular apparatus. This increases the production of angiotensin and in turn, raises the production of aldosterone. By the combined effect of the reduced glomerular sodium load and aldosterone-mediated increase in tubular reabsorption of sodium, sodium and water will be retained in the body. During the night-rest the load on the circulatory system diminishes. In the early stages of heart-failure this emergency circulatory reaction, therefore, subsides and the rise of the renal fraction of the cardiac output leads to the excretion of the retained fluid and is the basis of nocturia.

Topics: Blood Proteins; Capillaries; Chlorides; Circadian Rhythm; Dibenzylchlorethamine; Dihydroergotoxine; Edema; Extracellular Space; Glomerular Filtration Rate; Heart Failure; Hemodynamics; Humans; Hypertension; Juxtaglomerular Apparatus; Kidney; Regional Blood Flow; Renin; Sodium; Sympathetic Nervous System; Vasomotor System; Water-Electrolyte Balance