Sakurada H, Motomiya T, Hiraoka M
Department of Cardiology, Tokyo Metropolitan Hiroo General Hospital, Japan.
Cardiovasc Drugs Ther. 1991 Aug;5 Suppl 4:835-41. doi: 10.1007/BF00120832.
The efficacy of oral disopyramide and mexiletine used alone or in combination was studied in 75 patients with frequent ventricular premature beats (VPBs). The efficacy was evaluated with 24-hour ambulatory ECG and greater than or equal to 75% reduction in the number of VPBs was defined as effective. When disopyramide or mexiletine were ineffective or not tolerated, the alternative drug was administered and the efficacy was again evaluated. If the single administration of neither drug was effective, the combination of disopyramide and mexiletine was then given. Either disopyramide or mexiletine was effective in 48 patients, and neither drug was effective in 19 patients. In 19 patients unresponsive to both drugs, combination therapy was effective in six patients (32%). Both drugs caused side effects or one drug caused side effects and another drug was ineffective in eight patients. In five out of those patients, we attempted combined therapy with a reduced dosage of those drugs that caused side effects. This therapy was effective in two patients without intolerable side effects. Thus, when the single use of neither disopyramide nor mexiletine single-drug therapy is effective, it is worthwhile to try combination therapy. Also, combination therapy with a reduced dosage of the drugs that caused side effects might be the therapy of choice in patients who have developed dose-dependent side effects.
对75例频发室性早搏（VPB）患者单独或联合使用口服丙吡胺和美西律的疗效进行了研究。通过24小时动态心电图评估疗效，VPB数量减少大于或等于75%被定义为有效。当丙吡胺或美西律无效或不耐受时，给予替代药物并再次评估疗效。如果两种药物单独使用均无效，则给予丙吡胺和美西律联合用药。丙吡胺或美西律单独使用时，48例患者有效，19例患者两种药物均无效。在对两种药物均无反应的19例患者中，联合治疗使6例患者有效（32%）。两种药物均引起副作用，或一种药物引起副作用而另一种药物无效的患者有8例。在其中5例患者中，我们尝试减少引起副作用药物的剂量进行联合治疗。该治疗方法使2例患者有效且无无法耐受的副作用。因此，当单独使用丙吡胺或美西律单药治疗均无效时，尝试联合治疗是值得的。此外，对于已出现剂量依赖性副作用的患者，减少引起副作用药物剂量的联合治疗可能是首选治疗方法。
