Side‐effects of beta‐adrenoceptor blocking drugs assessed by visual analogue scales.

Lewis, Robin; Jackson, Paul R.; Ramsay, LE

doi:10.1111/j.1365-2125.1985.tb02639.x

Cited by 15 publications

(6 citation statements)

References 3 publications

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“…It has been suggested, but never confirmed, that lipid-soluble ~-adreno ceptor antagonists such as propranolol might produce a higher incidence of central nervous system side effects than less lipid-soluble agents. The results in this area are conflicting, with some studies suggesting increased dreaming and wakefulness during therapy with lipid soluble ~-adrenoceptor antagonists (Betts & Alford 1985) and others failing to find an increase in the frequency of central nervous system side effects with lipid soluble ~ adrenoceptor antagonists (Gengo et al 1986;Lewis et al 1985). Because atenolol, sotalol, and nadolol are not extensively metabolised, these ~-adreno-62 ceptor antagonists may cause fewer interactions with drugs such as cimetidine which alter hepatic drug-metabolising capacity (Frishman & Kimmel 1983).…”

Section: Discussionmentioning

confidence: 96%

Pharmacokinetics of Long Acting Propranolol

Nace

Wood

1987

Clinical Pharmacokinetics

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Beta-adrenoceptor antagonists are among the most commonly prescribed classes of drugs. They are indicated for the treatment of diseases such as hypertension and angina pectoris, in which long term therapy is often required. Since many beta-adrenoceptor antagonists have short plasma elimination half-lives, divided daily dosing has often been necessary in order to provide continuous beta-blockade throughout the day. However, such multiple-dose schedules may promote patient non-compliance and failure of the prescribed regimen. Long acting propranolol is a sustained release formulation of propranolol which has been developed to maintain therapeutic plasma propranolol concentrations throughout a 24-hour period while allowing once-daily dosing. Compared with conventionally formulated propranolol, long acting propranolol has a prolonged terminal half-life (8 to 11 hours), due to slower absorption from the gut. Systemic bioavailability of long acting propranolol is 30 to 50% less than that of the conventional formulation. This difference may result from increased hepatic metabolism. Peak drug concentrations are significantly lower than following identical doses of conventional propranolol, and the time to peak drug concentrations following administration is delayed. Relatively constant plasma concentrations and clinically significant inhibition of exercise-induced tachycardia are maintained throughout a 24-hour dosing interval following once-daily long acting propranolol. Once-daily long acting propranolol is as effective as divided doses of conventional propranolol for the treatment of hypertension and angina pectoris. Efficacy also appears comparable with once-daily administration of long acting conventional beta-adrenoceptor antagonists such as atenolol and nadolol. Once-daily long acting propranolol provides clinically significant sustained beta-adrenoceptor blockade and offers the potential for improved patient compliance due to once-daily dosing. Since provision of sustained beta-adrenoceptor blockade appears to be particularly important in the treatment of angina, this may be the principal indication for which long acting propranolol has a therapeutic advantage independent of its potential to improve compliance.

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Section: Discussionmentioning

confidence: 96%

Pharmacokinetics of Long Acting Propranolol

Nace

Wood

1987

Clinical Pharmacokinetics

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“…Several of the drugs used, however, are associated with subtle subjective symptoms [9][10][11][12] and this might have an impact on the patients' general well-being, especially in view of the long duration of antihypertensive treatment.…”

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confidence: 98%

Documentation of an instrument for assessment of subjective CNS-related symptoms during cardiovascular pharmacotherapy

Dahlöf

Dimenäs

Olofsson

1989

Cardiovasc Drug Ther

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The aim of this work was to develop and initiate the documentation of an instrument for the assessment of subjective CNS-related symptoms occurring during cardiovascular pharmacotherapy. The self-applied questionnaire developed for minor symptom evaluation (MSE profile) includes 24 items and uses a visual analogue scale to record symptoms. Three different studies were performed using a total of 86 healthy volunteers. Based on a subjective grouping followed by principal component analysis to confirm the grouping, three dimensions-contentment (eight items), vitality (five items), and sleep (three items)-were formed. The Cronbach's alpha coefficient, used to evaluate the internal consistency of these dimensions, was found to be 0.90, 0.88, and 0.85, respectively. To validate the MSE profile, the subjective symptoms of two classes of drugs with well-known symptom profiles, a nonselective, beta-blocker (propranolol) and a benzodiazepine (oxazepam), were compared in placebo-controlled randomized double-blind crossover studies. The obtained results indicate that the symptom profiles were different but were compatible with the previously reported effects of these compounds. It can be concluded that the MSE profile is practical, useful, and sensitive enough to also detect subtle drug-induced effects.

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“…These dummy scales could then be used to "measure" the patients' likelihood to report side effects. With these scales the following side effects were observed more often ( P < 0.005) during p-blocker treatment: tired legs, cold digits, and insomnia (12). Similar scales would probably result in a more objective evaluation of side effects in migraine trials.…”

Section: Discussionmentioning

confidence: 88%

“…I think there is probably a need for more objective measurements of side effects. This was recently done with visual analogue scales in hypertensive patients treated with /3-blockers (11,12). Of 16 presented scales, 3 were dummy scales with symptoms unrelated to /%blocker therapy.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of β-Blockers in Migraine

Tfelt‐Hansen

1986

Cephalalgia

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Five double-blind trials of the prophylactic treatment of migraine with beta-blockers were reviewed critically with regard to problem investigated, design, "blindness" of patient, side effects, statistical validity, and conclusions. The initial use of a "responder-finding" period may limit the validity of results from a subsequent double-blind crossover placebo-controlled study because it may impair "blindness". A d-propranolol versus racemic propranolol versus placebo study was reanalysed with conventional statistical methods, which showed that d-propranolol had no significant effect. In a multicentre study including 96 patients calculation of 95% confidence limits demonstrated that timolol and propranolol are equally effective in common migraine prophylaxis. Metopropolol and propranolol were apparently equally effective in 34 patients, but the calculation of confidence limits showed that a larger study is needed to confirm this conclusion. A group comparison study with three doses of nadolol and placebo lacked statistical evaluation of the results, thereby making it impossible to draw a conclusion about the efficacy of nadolol. It is concluded that there are considerable methodological problems in published papers on beta-blocker and migraine.

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Side‐effects of beta‐adrenoceptor blocking drugs assessed by visual analogue scales.

Cited by 15 publications

References 3 publications

Pharmacokinetics of Long Acting Propranolol

Pharmacokinetics of Long Acting Propranolol

Documentation of an instrument for assessment of subjective CNS-related symptoms during cardiovascular pharmacotherapy

Efficacy of β-Blockers in Migraine

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