Diazepam in acute myocardial infarction. Clinical effects and effects on catecholamines, free fatty acids, and cortisol.

Melsom, Morten Nissen; Andreassen, Paul R.; Melsom, Helene Støle; Hansen, Tonya Moen; Grendahl, H; Hillestad, Leif

doi:10.1136/hrt.38.8.804

Cited by 51 publications

(25 citation statements)

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“…One possible explanation might be the reduction of sympathetic activation because of its anxiolytic and stress-reducing activity diazepam may attenuate the reactivity to external stimuli and the consequent increase in sympathetic activity. The possibility of a diazepam-induced attenuation of sympathetic outflow is supported by the observation that diazepam can reduce the release of plasma catecholamines, especially norepinephrine [22, 23]. …”

Section: Discussionmentioning

confidence: 88%

“…The use of diazepam for inducing anesthesia was found to produce a transient depression of baroreflex function and a reduction of plasma noradrenaline [22]. In a small study, the administration of diazepam in patients with myocardial infarction (MI) at the moment of hospitalization and in the following 3 days was found to produce a significant reduction of urinary adrenaline [23]. This effect, however, might be secondary to the reduced stress experience.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Diazepam on 24-Hour Blood Pressure and Heart Rate in Healthy Young Volunteers

et al. 2017

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Aim: To assess the effects of evening chronic administration of diazepam on 24-h blood pressure (BP) and heart rate (HR) in healthy young adults. Methods: This randomized double blind, cross-over study evaluated the effects of diazepam 5 mg or placebo, both ingested in the evening, on 24-h ambulatory BP and HR in healthy subjects aged 21–30. Results: A total of 30 subjects were included in the analysis. At the end of 4-week diazepam intake, an increase in 24-h HR mean values was found (+5.2 beats/min, p < 0.05). Analysis of subperiods showed that diazepam produced a 10.1% increase in night-time HR (+6.1 beats/min, p < 0.01) without affecting BP. A significant HR rise (+4.9 beats/min, p < 0.05) and SBP reduction (–3.8 mm Hg, p < 0.05) were observed in the morning hours. The HR increase persisted in day-time hours (+4.6 beats/min, p < 0.05), while BP values resulted unaffected. Conclusions: In healthy subjects, diazepam taken as a hypnotic agent induces a significant HR increase, possibly mediated by a decrease in vagal tone. This effect might be of clinical relevance due to the role that HR plays as an independent cardiovascular risk factor.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Effect of Diazepam on 24-Hour Blood Pressure and Heart Rate in Healthy Young Volunteers

et al. 2017

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“…BZPs have also been shown to attenuate or block the increase in plasma cortisol associated with various types of acute stressors, such as preoperative stress, painful electrical stimulation, hypoglycemia, and metabolic stress (Breier et al, 1991;Collomp et al, 1994;Goldstein et al, 1982;Joyner et al, 1998;Judd et al, 1995;Kertesz et al, 1985;Melsom et al, 1976;Pruneti et al, 2002;Rodriguez-Huertas et al, 1992;Roy-Byrne et al, 1988;Santagostino et al, 1996;Sevy et al, 1994;Torpy et al, 1993Torpy et al, , 1994Vongsavan et al, 1990). Acute doses of both diazepam and alprazolam have been associated with reductions in plasma cortisol, although the effect produced by alprazolam has been more consistent De Souza, 1990).…”

Section: Introductionmentioning

confidence: 99%

Interdose Elevation in Plasma Cortisol During Chronic Treatment with Alprazolam but not Lorazepam in the Elderly

Pomara

Willoughby

Ritchie

et al. 2003

Neuropsychopharmacol

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Benzodiazepines (BZPs) have been shown to reduce hypothalamic-pituitary-adrenal (HPA) axis activity acutely in normal humans. In contrast, the effects of chronic BZP treatment on the HPA axis have not been well studied, especially in the geriatric population. This study examined the acute and chronic effects (3 weeks) of alprazolam and lorazepam on plasma cortisol in 68 subjects (60-83 years) who received 0.25 or 0.50 mg b.i.d. alprazolam, or 0.50 or 1.0 mg b.i.d. lorazepam, or placebo orally according to a randomized, doubleblind, placebo-controlled parallel design. Memory assessment and blood samples for plasma cortisol were obtained prior to the morning dose on days 0, 7, 14, and 21, and at 1, 2.5, and 5 h postdrug on days 0 and 21. Assessments of anxiety and depression were carried out at days 0, 7, 14, and 21 before drug administration. Plasma cortisol was affected compared to placebo only by the 0.5 mg alprazolam dose. During the first and the last day of treatment, there was a significant drop in cortisol at 2.5 h after alprazolam compared to placebo. The predose cortisol levels increased significantly during chronic alprazolam treatment, and correlations were found between these cortisol changes and changes in depression, anxiety, and memory scores. These findings suggest that even a short period of chronic treatment with alprazolam, but not lorazepam, may result in interdose HPA axis activation in the elderly, consistent with drug withdrawal. If confirmed, this effect may contribute to an increased risk for drug escalation and dependence during chronic alprazolam treatment.

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“…Short-term alprazolam treatment in patients with recent AMI suppresses salivary cortisol secretion and modifies their behavioral and psycho-physiological status 47 . Diazepam lowers stress reaction, mean noradrenaline and adrenaline secretion rates, and malignant arrhythmias within the first 12 h after hospital admission 48 . As agents reducing psychological stress, benzodiazepines should be used to prevent SCD in patients in the earliest pre-hospital phase of AMI (ref.…”

Section: Beta-blockers Benzodiazepines and Sympathetic Denervation mentioning

confidence: 99%

Class I and III antiarrhythmic drugs for prevention of sudden cardiac death and management of postmyocardial infarction arrhythmias. A review

Vrána

Pokorný²,

Marcián³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. The aim of the present paper is to review the evolution of concepts regarding the use of Class I and III antiarrhythmic drugs (AADs) in myocardial infarction over the past four decades. Methods. Results of animal experiments carried out by the authors and papers published between 1970 and 2012 in journals and the PubMed search system were used. Results. Animal experiments carried out as early as the 1970s showed that Class IB and IC AADs lose their antiarrhythmic effect and electrically destabilize ventricles in the very early phase of myocardial ischemic focus formation. The cause of this is interaction between Class IB and IC AADs as well as Class III AADs with sympathetic neural activation (SNA) of the heart in the early phase of myocardial ischemia. Given the extremely high and uneven distribution of noradrenaline in tissue, SNA results in dispersion of the depolarization and repolarization processes in the ventricles. The clinical sequels of the interaction between the effects of AADs and SNA are as follows: the antiarrhythmic effect of AADs is restored in AMI once SNA has resolved; membrane-destabilization of the ventricles can be restored any time in the presence of randomly occurring SNA not only due to increasing myocardial ischemia but, also, as a result of psychological stress (emotions), and any pre-existing structural heart disease will enhance the pro-fibrillatory effect of a randomly occurring SNA. Conclusions. Despite the above risks, AADs continue to play an irreplaceable role in suppressing post-myocardial arrhythmias and in preventing sudden cardiac death following ICD placement. The risk of AADs' proarrhythmic effect in SNA can be reduced by combining them with beta-blockers. The last recourse when attempting to suppress malignant ventricular tachyarrhythmias is left sympathetic denervation of the heart.

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Diazepam in acute myocardial infarction. Clinical effects and effects on catecholamines, free fatty acids, and cortisol.

Cited by 51 publications

References 0 publications

Effect of Diazepam on 24-Hour Blood Pressure and Heart Rate in Healthy Young Volunteers

Effect of Diazepam on 24-Hour Blood Pressure and Heart Rate in Healthy Young Volunteers

Interdose Elevation in Plasma Cortisol During Chronic Treatment with Alprazolam but not Lorazepam in the Elderly

Class I and III antiarrhythmic drugs for prevention of sudden cardiac death and management of postmyocardial infarction arrhythmias. A review

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