Is There a Difference Between the Acute and Chronic Anti-Ischemic Efficacy of Nisoldipine?

Summary

The number of calcium channel-blocking agents is still growing. The newly developed nisoldipine is a dihydropyridine derivative. In comparison with the mother compound nifedipine, nisoldipine has a higher vessel selectivity and a longer duration of action. This study was carried out to look for tolerance development or augmentation of antiischemic effects by comparing the results on the 1st day with those on the 21st day of treatment.

In 12 patients with angiographically documented coronary artery disease, nisoldipine was tested (10 mg twice daily) in a double-blind, randomized, placebo-controlled crossover study. Ergometric measurements were performed on 1 days, and 21 before, 3 h, and 7 h after drug administration. We analyzed ST-segment depression (ST), time to ST-segment depression of 1 mm (ST-1), blood pressure (BP), and heart rate (HR). Results are expressed in percentage differences at 3 h (*, P < 0.05).

In the dosage used, nisoldipine acutely administered led to significant changes in ST, ST-1, BP, and HR. With the exception of HR, in all parameters nisoldipine led to the same changes after 3 weeks of treatment. Thus, a development of tolerance or an augmentation of effects was not detectable. Nisoldipine demonstrated an antiischemic effect at 7 h and 10 h, the extent of which was not diminished from that seen at 3 h. Some patients were nonresponders to the drug after acute and after long-term treatment. Nisoldipine was well tolerated, with no undesired side effects.

This study was performed at the German Heart Center, Munich