Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this two month, double-blind, crossover study, the efficacy and safety of tulobuterol aerosol (400 micrograms qid) was compared to fenoterol aerosol (400 micrograms qid) in patients with chronic obstructive lung disease. Thirty-six (36) adults with reversible bronchospasm were enrolled. All patients were evaluable. On set of response was within 5 minutes for both drugs. Mean increases in FEV1 were greater after tulobuterol than fenoterol at every time interval. Increases peaked at 30-60 minutes postdose. Duration of response was longer after tulobuterol with mean FEV1 remaining greater than 15% over baseline for at least 6 hours postdose. Mean predose FEV1 values were significantly greater after 2 and 4 weeks of tulobuterol treatment compared with fenoterol. Despite these large increases, changes in mean FEV1 from predose to 1 hour postdose at these visits were not significantly different between treatment groups. Results of plethysmography testing also indicated greater improvement after tulobuterol. In addition, improvement in pulmonary symptoms was more pronounced during tulobuterol therapy. Small changes in mean blood pressure occurred, with greater changes after fenoterol than after tulobuterol. Changes in mean pulse rate were significantly greater following fenoterol administration. No adverse reactions were reported during tulobuterol treatment; however, one patient experienced severe tremor, tachycardia, and sweating during fenoterol treatment and withdrew from the study prematurely. The results in this study indicate that tulobuterol aerosol is more effective than fenoterol aerosol in the treatment of patients with chronic obstructive lung disease, with fewer cardiovascular effects and no adverse reactions.
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PMID:Two-month comparative study of tulobuterol aerosol versus fenoterol aerosol in patients with chronic obstructive lung disease. 197 78

Eleven patients with chronic obstructive pulmonary disease (age, 61 +/- 2 yr; FEV1, 1.36 +/- 0.24 L, 46 +/- 7% predicted) were given 4 wk of treatment with either a conventional low dose of inhaled terbutaline (LDT), 500 micrograms four times a day, or a high dose of inhaled terbutaline (HDT), 2,000 micrograms four times a day, delivered by a spacer. A randomized double-blind crossover design was used with 2-wk run-in and washout periods, when ipratropium bromide was substituted for inhaled beta-agonists. Dose response curves (DRC) to cumulative doubling doses of inhaled terbutaline (125 to 4,000 micrograms) were constructed after each treatment period, and baseline spirometry, finger tremor (Tr), plasma potassium (K), plasma cAMP, and ECG (HR and T wave) were measured at each dose step of the DRC. Daily PEFR measurements (A.M. and P.M.) and Holter ECG were performed during run-in and treatment periods. Baseline values for FEV1 were not significantly different during run-in, treatment, or washout periods. There were dose-related increases in FEV1 (p less than 0.0001) with no significant differences between DRC after treatment with HDT compared with those with LDT: delta FEV1 max, 0.46 +/- 0.14 L, 15.5 +/- 3.7% predicted (HDT); 0.50 +/- 0.11 L, 16.0 +/- 3.1% predicted (LDT). There were also no differences between DRC for delta FVC: 1.08 +/- 0.22 L, 31.1 +/- 5.4% predicted (HDT); 0.99 +/- 0.14 L, 28.5 +/- 3.8% predicted (LDT). There were no significant changes in K or HR in response to cumulative doses of terbutaline after either treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of the effects of prolonged treatment with low and high doses of inhaled terbutaline on beta-adrenoceptor responsiveness in patients with chronic obstructive pulmonary disease. 216 55

Airflow limitation results from loss of elastic recoil (as in emphysema), or narrowing of large and small airways from smooth muscle contraction, mucosal swelling and/or oedema, mucous plugging (as in asthma), and loss of small airways (as in COPD). Bronchodilator regimes in asthma include inhaled beta 2-agonists, but these do not reduce bronchial hyper-reactivity but act quickly and synergise with oral slow-release theophyllines (serum level 10-20 micrograms/ml), without potentiating tremor which occurs with oral beta 2-agonists. Airway inflammation as the mechanism of asthma, although fashionable, remains unproven, and clearly requires to be specified for asthma. Inhaled steroids slowly improve FEV1 in asthma and in 10-20% of COPD, and reduce hyper-reactivity. Nedocromil has yet to reveal similar potency. Clinical trial of effective anti-PAF drugs or anti-leukotriene agents are awaited, but understanding the specific asthmatic inflammation is still needed for rational therapy. In COPD combining inhaled beta 2-agonists with ipratropium--both given by a reservoir device--can be effective, along with oral slow-release theophylline and possibly inhaled steroids. New inhalation devices (i.e. modified dry powder inhalers) will be needed as the freon propellents in MDI may soon cease manufacture due to potential environmental hazards.
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PMID:Today's treatment of airway obstruction ... and tomorrow's? 257 39

A double-blind study compared tulobuterol (2 mg BID), a new beta 2-adrenergic agent, with salbutamol (2 mg TID) in 40 hospitalized men with chronic obstructive pulmonary disease. The study evaluated the bronchospasmolytic effects of the two drugs and their selectivity of action. Measurements and observations were made for six hours after the first oral dose, daily during nine days of continuous therapy, and for 12 hours after the final dose on the tenth day. Results show that the tulobuterol regimen produced a significant (P less than 0.01) improvement of the forced expiratory volume in one second equal to an increase of 25% above the pretreatment value, versus 16% with the salbutamol regimen. Cardiovascular effects appeared more rapidly with tulobuterol, but they stabilized to values lower than those observed with salbutamol. No clinically important adverse reactions were reported other than slight tremor, which was not objectionable.
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PMID:Double-blind comparison of tulobuterol and salbutamol in chronic obstructive pulmonary disease. 287 75

The short- and long-term efficacy and safety of an inhaled quaternary ammonium anticholinergic agent, ipratropium bromide, and a beta agonist aerosol, metaproterenol, were compared in 261 nonatopic patients with chronic obstructive pulmonary disease (COPD). The study was a randomized, double-blind, 90-day, parallel-group trial. On three test days-one, 45, and 90-mean peak responses for forced expiratory volume in one second and forced vital capacity and mean area under the time-response curve were higher for ipratropium than for metaproterenol. Clinical improvement was noted in both treatment groups, especially during the first treatment month, with persistence of improvement throughout the remainder of the study. Side effects were relatively infrequent and generally mild; tremor, a complication of beta agonists, was not reported by any subject receiving ipratropium. These results support the effectiveness and safety of long-term treatment with inhaled ipratropium in COPD.
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PMID:Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease. A 90-day multi-center study. 294 65

This study was designed to compare the initial tremor response to 4.0 mg albuterol and 5.0 mg terbutaline orally administered and to study the question of tachyphylaxis by rechallenge after 3 wk of maintenance dosing. Twenty fasting patients with severe COPD in whom orally administered sympathomimetics were withheld for 2 wk were challenged with single doses of each drug in a crossover, randomized fashion 1 wk apart. Then after a further 3 wk of dosing 3 times a day of the second medication (10 patients received each medication), they were challenged once more 16 h after the last dose. Rest and postural tremor were measured at zero and 2 h using an accelerometer affixed to the finger, and measurements of subjective tremor, tremor power spectrum, plasma cyclic AMP and lactate, and forced vital capacity were also made. Postural tremor increased from 25.05 to 36.20 relative units for albuterol, an increase of 11.15 units, and from 24.90 to 57.70 units for terbutaline, an increase of 32.80 units (difference significant at p = 0.01). Plasma cyclic AMP (p less than 0.01) and lactate (p = 0.05) increases were also less for albuterol, and the FEV1 and FVC responses, though about one third less, did not differ significantly. After 3 wk, mean baseline tremor for both drugs was elevated even 16 h after the last 3 times a day dosing (38.00 and 33.10) for albuterol and terbutaline (difference, NS), and responses were much less to the single tablet (3.40 and 9.10, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of tremor responses to orally administered albuterol and terbutaline. 376 27

Enprofylline is a potent bronchodilating xanthine derivative that has been shown to have little or no ability to antagonize adenosine in a variety of cell types. In eight patients with chronic obstructive lung disease, a single dose of enprofylline (3.5 mg/kg) was given orally. A double blind, randomized, crossover comparison was made with oral theophylline (9.5 mg/kg) which is a potent and general adenosine receptor antagonist. Forced expiratory volume (FEV1), vital capacity, tremor of hands, heart rate, and blood pressure were followed for 6 h. Plasma concentrations of both drugs were monitored. At doses producing significant bronchodilation, theophylline caused a significant increase in tremor of hands whereas enprofylline did not. There were no significant changes in heart rate or blood pressure after either drug. It is suggested that the lack of tremorogenic effect of enprofylline is related to its lack of CNS-stimulating behavioural effects and, hence, may reflect its low tendency to antagonize neuro-depressant actions of adenosine. The adenosine-blocking mechanism may not be important for the bronchodilating effects of xanthines.
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PMID:A novel bronchodilator xanthine apparently without adenosine receptor antagonism and tremorogenic effect. 630 42

Objective and subjective postural tremor responses at 60 and 120 min after drug treatment were studied in 24 veterans with chronic obstructive pulmonary disease who received either 5 mg terbutaline, 20 mg metaproterenol, or a placebo in random order. Subjects were fasting, and had not taken theophylline for 15 to 24 h or any oral sympathomimetics for 2 wk. The mean tremor response to terbutaline and metaproterenol was equal at 60 min, but the 120-min response to metaproterenol was less. When the 60- and 120-min responses were averaged, tremor response to terbutaline was significantly greater than that to metaproterenol in a 5 : 4 ratio. Subjective awareness was also greater. These results are consistent with the difference in bronchodilatory potency of the two preparations. That the drug producing the greater tremor could usually be identified by the patient, even at low tremor intensities, is consistent with the hypothesis that perception of tremor is a function of relative rather than absolute increase over basal tremor unless the tremor becomes physically disabling. In general, the individual tremor response was proportional to the extent by which a patient's basal tremor exceeded the minimal basal tremor for the group as a whole. These results fit a model in which the postural tremor derives from beta-sensitive and beta-insensitive cardioballistic and skeletal muscle forces. Variability in tremor response resides principally at the peripheral skeletal beta 2-receptor and its control system.
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PMID:Objective and subjective tremor responses to oral beta 2 agents on first exposure. A comparison of metaproterenol and terbutaline. 675 Nov 76

The bronchospasmolytic action of proxyphylline given intravenously in a dosage of 16 mg/kg body weight was assessed by spirometry and bodyplethysmography in 12 patients with chronic obstructive pulmonary disease. Proxyphylline serum levels were estimated in parallel repeatedly. In the majority of patients a bronchospasmolytic effect could be established (lowering of airway resistance by 30% in 9 and by 40% in 7 patients). In some an action was demonstrated for up to 4 hours. There were no serious side effects and in particular no adverse cardiovascular reactions or skeletal muscular tremor.
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PMID:[Effectiveness of proxyphylline in chronic obstructive pulmonary disease (author's transl)]. 740 64

A field study of 239 horses was conducted to determine the efficacy and safety of clenbuterol HCl, a beta 2-adrenergic bronchodilator, when administered incrementally to effect in the treatment of chronic obstructive pulmonary disease (COPD). The severity of COPD (heaves) and response to treatment was determined by clinical evaluation; an overall 'heaveiness rating' (OHR) was assigned at each observation. The horses were treated orally b.i.d. with clenbuterol (as Ventipulmin Syrup), beginning with the lowest dosage of 0.8 micrograms/kg. On day 10 of treatment at the effective dose (0.8, 1.6, 2.4 or 3.2 micrograms/kg), treatment was either withdrawn (Schedule A) or continued for an additional 20 days (Schedule B). Horses on Schedule A demonstrated a significant improvement in the mean OHR on treatment Day 10 compared to the baseline overall heaveiness rating (BOHR) and a significant increase in the mean OHR (relapse) after the drug was withdrawn. Schedule B horses showed significant improvement (compared to BOHR) on treatment Days 10, 20 and 30. Incremental dosing with clenbuterol provided clinical improvement in 75% of the horses with a lower 95% confidence limit of 71%. Twenty-five percent were nonresponders. A greater percentage of the more severely affected horses required the 3.2 micrograms/kg dosage or were nonresponders compared to horses with a lower BOHR. Side effects of sweating, muscle tremor, and nervousness were of low intensity (mild to moderate) and frequency (< 7% of all observations) due to the regimen of incremental dosing to effect.
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PMID:Clinical efficacy and safety of clenbuterol HCl when administered to effect in horses with chronic obstructive pulmonary disease (COPD). 857 91


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