Tandem D. O. M.

Perhexiline [2-(2,2-dicyclohexylethyl)piperidine] maleate

“…Although it is reported to be effective even for those patients who do not respond well to treatment with beta blockers, this drug is not in widespread use. This may be due, in part, to the many side effects associated with long-term therapy (Cooper, Evans & Whibley, 1984), including hepatic damage (Forbes, Rake & Taylor, 1980;Pieterse, 1983), peripheral neuropathy (Hauw, Mussini, Boutry, Harpin, Escourolle, Pollet, Albouz & Baumann, 1981) and hypoglycemia (Houdent, Wolf & Corriat, 1977), among others; all of these side effects are reversible when perhexiline administration is ended unless hepatic cirrhosis has developed (Pessayre, Bichara, Feldmann, Degott, Potet & Benhamou, 1979). Since perhexiline is very lipid soluble, renal excretion of the drug can only occur if prior solubilization by hydroxylation occurs; a genetic inability to perform this hydroxylation, presumably owing to lack of sufficient appropriate enzymes, has been reported in persons experiencing serious side effects during therapy (Singlas & Simon, 1981).…”