Comparison of phenoxybenzamine and doxazosin in perioperative management of patients with pheochromocytoma

Malec, Klaudia; Miśkiewicz, Piotr; Witkowska, Agnieszka J.; Krajewska, Ewa; Toutounchi, Sadegh; Gałązka, Zbigniew; Piotrowski, M; Kącka, Agata; Bednarczuk, Tomasz; Ambroziak, Urszula

doi:10.5603/kp.a2017.0147

Cited by 22 publications

(23 citation statements)

References 15 publications

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“…43 Phenoxybenzamine has a longer duration of action in clinical studies than phentolamine 7 and hence its continued use in pheochromocytoma (although similar outcomes have been reported with doxazosin, terazosin, and prazosin,. [45][46][47] Sodium thiosulfate also rapidly reacts with the ethyleniminium ions thus prevents them from interacting with α adrenoceptors. 44 Pretreatment with intravenous sodium thiosulfate prevented dibenamine binding to α adrenoceptors (in cats, 48 and pretreatment with sodium thiosulfate prevented the The maximum concentration of competing ligand inhibited most but not all of specific binding (as in Figure 1E).…”

Section: Discussionmentioning

confidence: 99%

The affinity and selectivity of α‐adrenoceptor antagonists, antidepressants, and antipsychotics for the human α1A, α1B, and α1D‐adrenoceptors

Proudman

Pupo

Baker

2020

Pharmacology Res & Perspec

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Section: Discussionmentioning

confidence: 99%

The affinity and selectivity of α‐adrenoceptor antagonists, antidepressants, and antipsychotics for the human α1A, α1B, and α1D‐adrenoceptors

Proudman

Pupo

Baker

2020

Pharmacology Res & Perspec

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“…With respect to hemodynamic instability, some studies reveal that phenoxybenzamine is as effective as doxazosin (15,23). However, most studies report that doxazosin is associated with less adverse effects than phenoxybenzamine, such as reflex tachycardia, postoperative hypotension, edema, and nasal congestion (16,19,20,22). In general, both phenoxybenzamine and doxazosin are able to effectively control perioperative blood pressure and to prevent hemodynamic instability in patients of PPGL.…”

Section: Non-selective or Selective A-ar Antagonists?mentioning

confidence: 99%

“…However, many retrospective and prospective studies have made efforts to compare these two types of drugs. Some studies show that non-selective α-AR antagonists, phenoxybenzamine, and selective α-AR antagonist, doxazosin, have similar effects on controlling blood pressure ( 16 , 19 , 20 ), while some studies report that hypertension is better controlled by phenoxybenzamine than by doxazosin ( 15 , 21 , 22 ). With respect to hemodynamic instability, some studies reveal that phenoxybenzamine is as effective as doxazosin ( 15 , 23 ).…”

Section: Non-selective or Selective α-Ar Antagonists?mentioning

confidence: 99%

Preoperative Management of Pheochromocytoma and Paraganglioma

Fang

Ding

et al. 2020

Front. Endocrinol.

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Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors, characterized by excessive release of catecholamines (CAs), and manifested as the classic triad of headaches, palpitations, profuse sweating, and a variety of other signs and symptoms. The diagnosis of PPGL requires both evidence of excessive release of CAs and anatomical localization of CA-secreting tumor. Surgery is the mainstay of treatment for all patients with PPGL unless contraindicated. However, without proper preparation, the release of excessive CAs, especially during surgery, can result in lethal cardiovascular complications. Herein, we briefly reviewed the pathogenesis of this disease, discussed the current approaches and evidence available for preoperative management, summarizing the results of the latest studies which compared the efficacies of preoperative management with or without a adrenergic-receptor antagonists, aiming to facilitate better understanding of the preoperative management of PPGL for the physicians.

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“…DOX was associated with fewer sustained postoperative hypotension events and better postoperative hemodynamic recovery than were nonselective adrenergic blockers [ 13 ]. The duration of preoperative administration of DOX was negatively correlated with the maximum intraoperative blood pressure [ 17 ]. However, the optimal duration of preoperative α1-selective adrenergic receptor blockers remains unclear [ 3 ], and evidence for the most appropriate duration of preoperative preparation with DOX is lacking.…”

Section: Discussionmentioning

confidence: 99%

The use of doxazosin before adrenalectomy for pheochromocytoma: is the duration related to intraoperative hemodynamics and postoperative complications?

Kong

Tian

et al. 2020

Int Urol Nephrol

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Purpose No conclusion exists for the optimum duration of preoperative administration of doxazosin (DOX) before adrenalectomy for pheochromocytoma. The purpose of this study is to investigate whether perioperative hemodynamics and postoperative outcomes are related to the duration of DOX administration. Methods In total, 132 patients managed preoperatively with single α-receptor blocker DOX were enrolled. All patients underwent adrenalectomy for pheochromocytoma in the Department of Urology, Peking University First Hospital, between January 2001 and July 2019. Patients were divided into three groups based on the duration of preoperative administration of DOX: group A (≤14 days), group B (15–30 days), and group C (>30 days). Patient and tumor characteristics, intraoperative hemodynamics, and postoperative outcomes were recorded and compared. Results These patients included 57 men and 75 women, with an average age of 48 years. Clinical characteristics, preoperative hemodynamics, medicine management and surgical approaches were comparable between the three groups. Among the three groups, we found that group C (>30 days) had the lowest intraoperative minimum heart rate [group A vs. group B vs. group C = 60 (52–67) vs. 59 (50–61) vs. 51.5 (50–58.75), p = 0.024] and highest risk of postoperative hypotension requiring vasopressor support [group A vs. group B vs. group C = 14 (20.3%) vs. 12 (27.9%) vs. 10 (50.0%), p = 0.032]. Conclusion The current study indicated that preoperative management of pheochromocytoma with single α-receptor blocker DOX for more than 30 days after final dose adjustment might lead to intraoperative bradycardia and more postoperative hypotension requiring vasopressor support. Thus, our study does not support long-term (over 30 days) preoperative administration of pheochromocytoma with single α-receptor blocker DOX in the final dose.

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Comparison of phenoxybenzamine and doxazosin in perioperative management of patients with pheochromocytoma

Abstract: There are no clinically relevant differences between patients with pheochromocytoma, who have been prepared for adrenalectomy with DOX or PhB.

Cited by 22 publications

References 15 publications

The affinity and selectivity of α‐adrenoceptor antagonists, antidepressants, and antipsychotics for the human α1A, α1B, and α1D‐adrenoceptors

The affinity and selectivity of α‐adrenoceptor antagonists, antidepressants, and antipsychotics for the human α1A, α1B, and α1D‐adrenoceptors

Preoperative Management of Pheochromocytoma and Paraganglioma

The use of doxazosin before adrenalectomy for pheochromocytoma: is the duration related to intraoperative hemodynamics and postoperative complications?

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