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Role of Phenylalkylamine Calcium Antagonists in the Treatment of Ischaemic Heart Disease

Summary

The phenylalkylamine family is a class of calcium antagonists with specific pharmacological and clinical characteristics. The wide use of the prototype of the family, verapamil, and of its more recently introduced derivatives, such as gallopamil, has highlighted differential effects on cardiovascular protection compared with dihydropyridine and benzothiazepine compounds. The reduction in myocardial oxygen consumption, obtained by means of negative chronotropic and inotropic effects, together with antispastic and coronary dilatation actions, make the phenylalkylamines drugs of choice in the treatment of ischaemic heart disease.

The trials conducted in postmyocardial infarction patients using dihydropyridines have shown a worsening prognosis with a higher incidence of mortality and reinfarction. In addition, in studies carried out in patients treated with diltiazem, a deterioration in cardiac function was noted. However, in the DAVIT II study, verapamil showed a statistically significant reduction in the first major event and reinfarction, as well as a significant reduction in mortality in patients without signs of heart failure. Furthermore, evaluation of the combined data from the DAVIT I and DAVIT II studies reveals a reduction of 22% in mortality and 27% in the incidence of reinfarction, equivalent to that achieved with β-blockers.

Thus the phenylalkylamines provide an effective alternative to β-blockers when the latter are contraindicated in postmyocardial infarction patients.

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Correspondence to Dr F. Tartagni.

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Tartagni, F., Magnani, B. Role of Phenylalkylamine Calcium Antagonists in the Treatment of Ischaemic Heart Disease. Drug Invest 5, 177–185 (1993). https://doi.org/10.1007/BF03258444

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Keywords

  • Verapamil
  • Nifedipine
  • Diltiazem
  • Calcium Antagonist
  • Drug Invest