Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To compare the clinical efficacy and dose equivalency of standard nifedipine versus a new gastrointestinal therapeutic system (GITS) formulation of nifedipine, 98 patients with chronic stable angina pectoris participated in a 14-week, multicenter, open-label, crossover trial. All patients were administered nifedipine capsules for one month prior to study entry and continued receiving other antianginal, non-calcium blocker medications. Ninety-one patients (93 percent), 80 men and 11 women, mean age 62 +/- 1 years, completed the trial, which included two weeks receiving standard nifedipine followed by 12 weeks receiving nifedipine GITS starting at a dosage equal to the 24-hour total dose of nifedipine capsules and titrated upward as necessary. However, throughout the trial, mean nifedipine dosage was similar on nifedipine GITS compared with standard nifedipine. Angina frequency was significantly less with nifedipine GITS at Weeks 6, 10, and 14 (0.8 episodes/week) compared with baseline with standard nifedipine (1.3 episodes/week, p less than 0.05). Likewise, nitroglycerin consumption was also less at Weeks 6, 10, and 14, but only significantly less at Week 6 (nifedipine 1.2/week versus nifedipine GITS at six weeks, 0.7/week; p less than 0.05). Resting hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were not significantly different with standard nifedipine versus nifedipine GITS during the 12-week study. Total incidences of side effects were similar for both treatments (standard nifedipine, 16; nifedipine GITS, 17). However, incidence of vasodilator side effects (flushing, dizziness, and light-headedness) was significantly less frequent with nifedipine GITS (standard nifedipine, 12; nifedipine GITS, six; p less than 0.05). Thus, results from this open-label, crossover trial suggest that nifedipine GITS dosing is similar to multidose standard nifedipine with equivalent 24-hour efficacy for nifedipine GITS.
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PMID:Nifedipine gastrointestinal therapeutic system in stable angina pectoris. Results of a multicenter open-label crossover comparison with standard nifedipine. 314 Jun 60

Detection of coronary artery disease (CAD) in patients with aortic valve stenosis (AS) is clinically difficult. Thallium-201 images were generated in 27 patients with AS during combined intravenous dipyridamole and handgrip test, which induces a marked acute increase in coronary blood flow. Isolated AS was noted in 21 patients and combined AS and aortic regurgitation in 6. Thirteen patients had more than 50% diameter stenosis in 1 or more coronary arteries on angiography. Eleven of them had reversible perfusion defects on post-stress thallium scans (sensitivity 85%). Two patients had thallium defects without angiographic evidence of significant CAD (specificity 86%). In the other 12 patients with normal coronary angiographic findings, the thallium scans were normal. Two patients had dizziness and hypotension after dipyridamole infusion, which disappeared during the handgrip test; 2 others had chest pain during handgrip. One of them was treated with aminophylline and the other with aminophylline and nitroglycerin. No other adverse effects were reported by the patients and no major complications occurred during stress testing. Thus, thallium imaging during combined intravenous dipyridamole and handgrip test appears to be a promising noninvasive method of revealing CAD in patients with AS.
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PMID:Detection of coronary artery disease by thallium imaging using a combined intravenous dipyridamole and isometric handgrip test in patients with aortic valve stenosis. 381 85

The effects of bepridil, a calcium antagonist with a half-life of approximately 42 hr, were assessed in a double-blind, randomized, placebo-controlled crossover trial. Forty-four patients (39 men, five women) with exercise-induced angina pectoris and ST segment depression with exercise testing (modified Bruce protocol) were studied. Compared with placebo bepridil (400 mg daily) increased total exercise time, time to onset of angina, time to 1 mm of ST segment depression, time to 2 mm of ST segment depression, and total work achieved (all p less than or equal to .001). Both frequency of angina and nitroglycerin consumption decreased during the bepridil compared with the placebo period (p = .02 and .03, respectively). Minor side effects were noted during both the bepridil and placebo phases. Four patients experienced side effects that limited therapy (dizziness in three and abnormal results of liver function tests in one) and one patient died during the bepridil phase. This study suggests that bepridil, 400 mg daily, is effective for the treatment of exercise-induced myocardial ischemia and angina pectoris.
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PMID:Effect of bepridil in patients with chronic stable angina: results of a multicenter trial. 388 May 21

This study evaluated 1 year the efficacy of therapy with nicardipine in patients with chronic stable angina pectoris. Twenty-five male patients were entered. After a placebo run-in phase, the patients received nicardipine 30 mg, nicardipine 40 mg, and placebo, three times daily given in random, double-blind manner for 8 weeks. A double-blind, cross-over study comparing nicardipine with placebo was then undertaken. After 5 months of open treatment with nicardipine 90 or 120 mg day-1, patients received either placebo or nicardipine for 3 weeks, each followed by the alternative treatment for an additional 3 weeks and further open-label treatment with nicardipine for another 3-5 months. There were no significant changes in the PR, QRS or QT intervals, or in the QRS pattern during the short-term and long-term studies. There were no significant differences in mean heart rate after nicardipine compared with baseline. During treatment with nicardipine 120 mg day-1, patients reported significantly fewer anginal attacks compared with placebo, and nitroglycerin consumption also decreased. Nicardipine increased treadmill time, time to onset of angina, and time to one mm ST segment depression. These effects were maintained after 6 months of continued nicardipine therapy. Adverse effects were minor and well tolerated and included headache, dizziness, gastrointestinal upset, flushing paraesthesia and pedal oedema. Abrupt withdrawal of nicardipine at the end of the study resulted in a rapid return of the original symptoms but without further deterioration from the baseline measurements. Nicardipine was effective in the treatment of stable effort angina pectoris; this benefit was maintained for the entire year of treatment.
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PMID:Short- and long-term treatment of stable effort angina with nicardipine, a new calcium channel blocker: a double-blind, placebo-controlled, randomised, repeated cross-over study. 392 59

The antianginal efficacy of a transdermal therapeutic delivery system for nitroglycerin (TNG) was compared with that of placebo in a double-blind crossover study. Twenty-five patients with stable angina pectoris were evaluated. The transdermal system delivered 5 mg of nitroglycerin over a 24-hour period and was applied once every 48 hours. Treadmill exercise testing (Bruce protocol) was done 48 hours after the patch was applied in the first phase of the crossover and at the conclusion of the second phase of the crossover, 48 hours after the final dose of the second treatment. Exercise performance was significantly improved (P less than 0.05, analysis of covariance) with TNG as compared with placebo, as were frequency of episodes of angina and nitroglycerin consumption (P less than 0.05, analysis of variance). The incidence of mild-to-moderate headache in patients was greater during treatment with TNG (20%) than during placebo treatment (6.7%). Four cases of mild transient dermatitis and occasional reports of dizziness, lightheadedness, and nausea were noted.
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PMID:Sustained effects of transdermal nitroglycerin in patients with angina pectoris. 393 13

Recent reports have shown that beta-adrenergic blockade may exacerbate variant angina. On theoretical grounds, alpha-adrenergic blockade may be beneficial in these patients. To test this hypothesis, we assessed the efficacy of prazosin, an alpha-adrenergic blocking agent, in six men, mean age 49 years, with variant angina. Prazosin, 14.0 +/- 2.4 mg/day (mean +/- SD) in three equal doses, was compared with placebo in a double-blind, randomized, double-crossover trial lasting 4 1/2 months: 2 weeks of open-label prazosin followed by four 1-month periods of blinded alternating therapy. No other vasoactive medications were administered during the study. Prazosin reduced sitting systolic arterial pressure from 145 +/- 18 to 127 +/- 16 mm Hg (p = 0.02), but exerted no effect on diastolic arterial pressure or heart rate. Prazosin did not change the weekly number of episodes of chest pain (2.5 +/- 2.3 with placebo vs 3.1 +/- 3.0 with prazosin, NS), nitroglycerin tablets used (3.9 +/- 3.7 with placebo vs 4.6 +/- 4.2 with prazosin, NS), or transient ST-segment deviations (by calibrated two-channel Holter monitoring for 24 hours/week throughout the study) (6.5 +/- 10.1 with placebo vs 11.8 +/- 17.4 with prazosin, NS). During prazosin therapy, three patients had orthostatic dizziness and one patient had headache. Thus, in a long-term, randomized, double-blind trial, prazosin exerted no obvious beneficial effect in patients with variant angina.
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PMID:Alpha-adrenergic blockade for variant angina: a long-term, double-blind, randomized trial. 613 37

Bepridil, a calcium antagonist with a half-life of approximately 42 hours, was compared with placebo in a double-blind, randomized, crossover trial. Thirteen men (average age 62 years) with exercise-related angina pectoris and a positive exercise test (modified Bruce protocol) were studied. In the group as a whole, bepridil (400 mg once a day) caused an increased total exercise time (2.6 +/- 1.8 minutes, mean +/- standard deviation), time to onset of angina (3.3 +/- 1.6 minutes), time to 1 mm of ST-segment depression (2.2 +/- 2.3 minutes), time to 2 mm of ST-segment depression (2.4 +/- 1.4 minutes) and total work load achieved (1.8 +/- 1.4 kpm) compared with the preceding placebo phase (all p less than 0.05). Frequency of angina and nitroglycerin consumption were low and did not change significantly during bepridil therapy. Comparison of the 3 placebo periods (run-in, double-blind and washout) did not reveal a change in any measurement except time to onset of angina, suggesting no training effect or change in patient status. Adverse effects were common in patients taking both placebo and bepridil, but only 2 patients had adverse effects (dizziness) with bepridil that necessitated discontinuation of therapy. Similarity of the double product (systolic blood pressure X heart rate) at the end of exercise suggests a decrease in myocardial oxygen demand as the primary mode of action. This study suggests that bepridil is a promising agent for the treatment of exercise-induced myocardial ischemia.
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PMID:Effects of bepridil on exercise tolerance in chronic stable angina: a double-blind, randomized, placebo-controlled, crossover trial. 636 14

The efficacy and tolerability of nitroglycerin (NTG) ointment were studied in 80 male patients with severe angina pectoris. Two symptom-limited exercise tests were performed on successive days after application of an ointment containing 15 mg NTG or a placebo (P) ointment. The patients were assigned to 4 groups. The study was conducted in a double-blind, cross-over manner. The total amount of work performed was higher in all groups on NTG (46-70%) compared to P ointment. The difference was statistically significant (p less than 0.001) at all points of time from 0.5 to 7 hours. The ST segment depression in ECG at the end of the exercise test was slightly greater on P than on NTG, but the difference was statistically significant only in the 3-hour group (p less than 0.01). The frequencies of headache and dizziness were 35% and 16%, respectively, on NTG. Eight patients (10%) reported that headache was severe enough to prevent regular use of NTG ointment. NTG ointment is effective, has a long duration of action and is relatively well tolerated by patients with severe angina pectoris.
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PMID:Nitroglycerin ointment effective for seven hours in severe angina pectoris. 640 84

The antianginal action of a sustained-release preparation of isosorbide dinitrate (SUS-ID), administered twice a day, was examined in open trial in 61 patients with angina pectoris. The results obtained were as follows: 1) The frequency of anginal attacks as well as consumption of nitroglycerin tablets began to decrease significantly in the two weeks following the commencement of treatment with SUS-ID; increasing the dose and prolonging the period of administration resulted in further augmentation of its clinical effect. 2) The subjective symptoms improved in 44 of the 61 patients studied (72.1%), and 17 patients (27.9%) showed an improved electrocardiogram. 3) Both the systolic and diastolic blood pressures were significantly lowered, but little change in heart rate was observed. 4) According to the efficacy assessment by the doctors in charge, this drug was judged to be "effective and strongly recommendable" and to be "usable" in 56 of 61 patients (91.8%). Thus SUS-ID was considered to be of clinical usefulness. 5) In terms of side effects, 14 patients (23.0%) complained of headache and three patients (4.9%) of dizziness. These side effects, however, were not serious enough to cause withdrawal of the drug.
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PMID:Clinical effects of a sustained-release preparation of isosorbide dinitrate on angina pectoris. 677 14

Treatment of hypertension in the complicated patient requires a specialized approach focusing on the treatment of the blood pressure and concurrent medical problems. Therapy must be chosen in consideration of the patient's age, multiple illnesses, declining organ function, and possible drug interactions. This requires that the antihypertensive agent chosen have a demonstrated safe profile. In clinical trials, monotherapy with the calcium channel blocker (CCB) isradipine (ISR) at a recommended therapeutic dosage has controlled blood pressure with an excellent level of safety. In these studies, ISR had no significant effect on heart rate, cardiac conduction, or cardiac contractility and no negative effect on renal function. In hypertensive patients with both normal and impaired renal function, ISR significantly increased renal plasma flow while decreasing renal vascular resistance without decreasing glomerular filtration rate and filtration fraction. ISR has long-term natriuretic effects that may provide additional benefits in antihypertensive therapy. Most adverse effects associated with ISR are mild, transient, and related to vasodilation. The most frequently reported adverse reactions are headache, dizziness, and edema. ISR does not affect glycemic control or lipid metabolism in either diabetic or nondiabetic patients. It has no reported adverse interaction with some of the most commonly used medications for elderly patients, including digoxin, nitroglycerin, oral hypoglycemics, and hydrochlorothiazide. ISR may be used as a first-line agent for the treatment of hypertension in complicated patients.
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PMID:Antihypertensive therapy with isradipine in patients with special safety concerns. 798 35


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