Antimuscarinic action of methoctramine, a new cardioselective M-2 muscarinic receptor antagonist, alone and in combination with atropine and gallamine.

The antimuscarinic effects of methoctramine (N,N'-bis[6- [(2-methoxybenzyl)amino]hexyl]-1,8-octanediamine tetrahydrochloride) were investigated in vitro in isolated paced left (force) and spontaneously beating right (force and rate) atria of guinea pigs as well as ileum of guinea pig and rat. Methoctramine was a potent competitive antagonist of M-2 muscarinic receptors in myocardium and pacemaker cells over a wide range of concentrations. The pA2 values ranged from 7.74 to 7.93. They were not significantly different in the two cardiac preparations and were independent of the agonist used (muscarine and carbachol). A combination of methoctramine with atropine resulted in addition of the dose ratios for left atria, which is expected for two antagonists interacting competitively with the same receptor site. In contrast, a combination of methoctramine with gallamine produced a less than additive shift of the dose-response curve for carbachol, confirming that gallamine acts as an allosteric antagonist at cardiac muscarinic receptors. Methoctramine was 54 to 132-fold less potent in ileal than in atrial preparations (pA2 values ranging from 5.81 to 6.20) which makes it the most cardioselective antimuscarinic agent now available. A combination of methoctramine with atropine gave a slight supra-additive antagonism on guinea pig ileum, which suggests that methoctramine interacts to some extent with a second independent site. These results strongly reinforce the view that M-2 muscarinic receptors are not a homogeneous population.