Munger M A, Nara A R, Pospisil R A, Stoddard G J, Schleman M
Department of Pharmacy Practice, University of Utah, Salt Lake City 84112.
Pharmacotherapy. 1993 May-Jun;13(3):218-23.
To determine the acute hemodynamic response of single-dose coadministration of ibopamine plus nifedipine or diltiazem in patients with New York Heart Association functional class (NYHA FC) II-III congestive heart failure.
A single-blind, placebo-controlled, two-paired, crossover study.
Cardiology clinics at two large teaching hospitals.
Eight patients with NYHA FC II-III congestive heart failure who met the inclusion criteria were selected randomly.
All patients underwent right heart catheterization. Day 1 consisted of concomitant calcium channel blocker plus placebo, with cardiac and peripheral hemodynamic recordings from 30 minutes-24 hours. The design was equivalent on day 2, with single-dose administration of ibopamine plus calcium channel blocker.
Single-dose nifedipine-diltiazem augmented cardiac output and stroke volume secondary to decreasing systemic vascular resistance. The nifedipine-ibopamine and diltiazem-ibopamine subgroups demonstrated relatively equal hemodynamics, augmenting cardiac index (nifedipine 43%, p < 0.05; diltiazem 40%, p < 0.05 vs baseline) while decreasing systemic vascular resistance (nifedipine 41%, p < 0.05; diltiazem 28%, p NS vs baseline) 30 minutes after the dose. In contrast to single-dose diltiazem, the diltiazem-ibopamine subgroup exhibited an increased left ventricular filling pressure (122%, p < 0.05 vs baseline) and mean pulmonary artery pressure (43%, p < 0.05 vs baseline) at 30 minutes after the dose. One patient experienced a transient episode of chest pain associated with increased heart rate and blood pressure with diltiazem-ibopamine.
Diltiazem and ibopamine should be coadministered with caution in patients with coronary artery disease and left ventricular dysfunction.
