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Calcium channel blockers and dysmenorrhea.

Dysmenorrhea is a significant problem in adolescents. Routine medical management has included analgesics and prostaglandin inhibitors. We describe the use of a calcium channel blocker, nicardipine, in the management of an adolescent who was refractory in routine treatment for severe dysmenorrhea. The patient had excellent resolution of menstrual cramping without serious side effects. The role of calcium channel blockers in the management of refractory dysmenorrhea should be further studied to examine a future role.

Adolescent↗

Hemodynamic effects of the calcium channel blocker pranidipine on exercise-induced angina.

Hemodynamic effects of a newly developed calcium channel blocker, pranidipine, on dynamic exercise-induced angina were investigated. Ten patients with stable effort angina pectoris underwent symptom-limited bicycle ergometer exercise testings before and after a single oral administration of pranidipine, and effects of pranidipine on systemic, cardiac and coronary hemo-dynamics induced by dynamic exercise were evaluated invasively. Pranidipine administration reduced systemic vascular resistance (from 1,764 +/- 109 to 1,115 +/- 60 dynes.sec/cm5; p < 0.01 at test, and from 1,120 +/- 102 to 795 +/- 62 dynes.sec/cm5; p < 0.05 at peak exercise) and mean arterial pressure (from 93 +/- 5 to 76 +/- 3 mmHg; p < 0.01 at test, and from 85 +/- 7 to 72 +/- 6 mmHg; p < 0.05 at peak exercise) with the increase in heart rate and cardiac index throughout exercise. Pranidipine also decreased coronary vascular resistance from 1.29 +/- 0.21 to 0.89 +/- 0.17 mmHg/ml/min (p < 0.05) at resting condition. At peak exercise, rate-pressure product and myocardial oxygen consumption decreased (from 237 +/- 21 to 215 +/- 18 x 10(2); p < 0.05, and from 31.3 +/- 7.5 to 21.7 +/- 3.9 ml/min; p < 0.05, respectively), while coronary vascular resistance did not change significantly. Furthermore, pranidipine mitigated ST-segment depression and elevation of pulmonary artery wedge pressure at peak exercise (from 0.20 +/- 0.03 to 0.13 +/- 0.02 mV; p < 0.01, and from 25 +/- 3 to 11 +/- 2 mmHg; p < 0.01, respectively). These results suggest that the major therapeutic effects of pranidipine for dynamic exercise-induced angina would be to reduce myocardial oxygen demand by improving peripheral circulation and reducing preload and afterload.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Regression of nifedipine-induced gingival hyperplasia following switch to a same class calcium channel blocker, isradipine.

Patients with nifedipine-induced gingival hyperplasia (GH) often require continued calcium channel blocker therapy. Switches to diltiazem and verapamil have been described; however, these drugs are of a different chemical class and present therapeutic limitations in some patients. The purpose of this study was to evaluate the effect on nifedipine-induced GH of a switch to a dihydropyridine derivative with a low incidence of GH. Fourteen patients with nifedipine-induced GH were given a medical exam and a periodontal exam. The following parameters were assessed: probing depth (PD), gingival margin (GM), gingival thickness (GT), plaque index (PI), and gingival index (GI). Intraoral photographs, study models, and a gingival biopsy for histological examination were taken. Following baseline measures, patients were randomized to continued treatment with nifedipine or an equivalent dose of isradipine in a single-blind fashion. Biweekly periodontal parameters were taken for 8 weeks. At the end of 8 weeks, some patients elected to receive 4 weeks of open label isradipine therapy, with biweekly examination continuing through the open label phase. The isradipine treatment arm showed a mean decrease in PD of 0.59 mm at week 8 (P < 0.05). No other measured parameter (GM, GT, PI, GI) was significantly changed, compared either to baseline or to the alternate treatment arm. Clinically, 60% of patients treated with isradipine exhibited a decrease in hyperplasia, while 66% of patients treated with nifedipine demonstrated an increase in hyperplasia, a significant difference (P < 0.05). When combined with open label data, patients switching therapy to isradipine exhibited an increase in GM (increase in recession) of 0.74 mm from baseline to week 12 (P < 0.05). No patients treated with isradipine exhibited an increase in gingival overgrowth. All patients exhibited adequate control of hypertension. We conclude that in hypertensive patients with nifedipine-induced GH, switching hypertensive therapy to isradipine may result in a regression of GH. When coupled with aggressive oral hygiene treatment, this drug may provide a reasonable option for patients requiring dihydropyridine treatment.

Adult↗

The binding of the calcium channel blocker, bepridil, to calmodulin.

Bepridil had the highest relative potency for inhibition of myosin light chain kinase (MLCK) activated by Ca2+-calmodulin of all the calcium channel blockers we examined. Kinetic analysis indicated that the primary effect of bepridil was mediated through a competitive inhibition of the enzyme activation by interaction with calmodulin and the apparent Ki value of this agent was 2.2 microM. We then examined the binding of bepridil to calmodulin, using the equilibrium column binding technique. [3H]bepridil bound to the calcium-calmodulin complex, but not to calmodulin in the presence of 2 mM EGTA. Scatchard analysis of the binding of bepridil to calmodulin demonstrated that the dissociation constant was 6.2 microM and the calculated number of specific binding sites was about 5 sites per molecule of calmodulin. The concentrations of unlabeled bepridil, W-7, prenylamine, verapamil and diltiazem producing 50% inhibition (IC50) of the binding of [3H]bepridil to calmodulin were 4 microM, 28 microM, 45 microM, 130 microM and 700 microM, respectively. However, nifedipine and nicardipine did not displace [3H]labeled bepridil from calmodulin. There was a good correlation between the displacement of [3H]bepridil from calmodulin and the inhibitory effect on MLCK by these calcium channel blockers and W-7. These results suggest that bepridil binds to calmodulin in the presence of calcium and potently inhibits the phosphorylation of myosin light chain.

Animals↗

The novel N-type calcium channel blocker, AM336, produces potent dose-dependent antinociception after intrathecal dosing in rats and inhibits substance P release in rat spinal cord slices.

N-type calcium channels modulate the release of key pro-nociceptive neurotransmitters such as glutamate and substance P (SP) in the central nervous system. Considerable research interest has focused on the therapeutic potential of the peptidic omega-conopeptides, GVIA and MVIIA as novel analgesic agents, due to their potent inhibition of N-type calcium channels. Recently, the novel peptidic N-type calcium channel blocker, AM336, was isolated from the venom of the cone snail, Conus catus. Thus, the aims of this study were to (i) document the antinociceptive effects of AM336 (also known as CVID) relative to MVIIA following intrathecal (i.t.) bolus dosing in rats with adjuvant-induced chronic inflammatory pain of the right hindpaw and to (ii) quantify the inhibitory effects of AM336 relative to MVIIA on K+-evoked SP release from slices of rat spinal cord. Both AM336 and MVIIA inhibited the K+-evoked release of the pro-nociceptive neurotransmitter, SP, from rat spinal cord slices in a concentration-dependent manner (EC50 values=21.1 and 62.9 nM, respectively), consistent with the antinociceptive actions of omega-conopeptides. Following acute i.t. dosing, AM336 evoked dose-dependent antinociception (ED50 approximately 0.110 nmol) but the doses required to produce side-effects were an order of magnitude larger than the doses required to produce antinociception. For i.t. doses of MVIIA 0.07 nmol, produced a dose-dependent decrease in antinociception but the incidence and severity of the side-effects continued to increase for all doses of MVIIA investigated, suggesting that dose-titration with MVIIA in the clinical setting, may be difficult.

Animals↗

Calmodulin inhibitors and calcium channel blockers influence dideoxycytidine renal excretion.

Renal handling of 2',3'-dideoxycytidine (ddC), a new anti-HIV dideoxynucleoside which undergoes renal and non-renal clearance, was determined in CF-1 male mice. Since calmodulin inhibitors (CIs) and calcium channel blockers (CCBs) have been shown to influence the flux of pyrimidine nucleosides across mammalian membranes and since the plasma concentration (and hence the efficacy) of therapeutic nucleosides is usually affected by the rate of renal elimination, we decided to determine the impact of the CIs loperamide (LOP) and trifluoperazine (TFP) as well as the CCB verapamil (VER) on the renal excretion of ddC. The ratio of ddC clearance to inulin clearance suggests that ddC undergoes secretion into renal tubules. Pre-exposure of mice to the calmodulin inhibitors loperamide (LOP) and trifluoperazine (TFP) resulted in a decrease in ddC renal secretion while pre-treatment with the calcium channel blocker verapamil increased ddC secretion.

Animals↗

Protective action of calcium channel blockers on Na+,K+-ATPase in gerbil cerebral cortex following ischemia.

The present study was initiated to determine whether pretreatment of gerbils with calcium channel blockers, flunarizine and verapamil would prevent injury to cerebral ATPases following secondary ischemia consisting of 60-min bilateral clamping of the carotids followed by 40 min of reperfusion. The sequence of ischemia produced a deficit in Na+,K+-ATPase activity without influencing Ca++,Mg++- or Mn++-sensitive ATPases. Pretreatment with flunarizine significantly prevented the damage to Na+,K+-ATPase while the effect of verapamil was marginal. Verapamil, along with dimethylsulfoxide (DMSO), reduced the mortality rate of gerbils subjected to the paradigm of ischemia. When added directly to the cerebral fractions in vitro the two calcium channel blockers inhibited Na+,K+-ATPase alone. Flunarizine was more potent in vitro than verapamil.

Animals↗

Effect of different calcium channel blockers on angiotensin II- and vasopressin-induced prostacyclin biosynthesis in vascular smooth muscle cells.

To gain insight with regard to the mode of action of calcium antagonists on the vasculature, we examined the effects of nifedipine, isradipine, felodipine, verapamil, gallopamil, and amlodipine on vasoconstrictor-induced prostacyclin synthesis in vitro. Cultured rat aortic smooth muscle cells were seeded after two to four passages in multiwell plates. After washing of the culture medium and a preincubation period, the cells were exposed for 1 h to either angiotensin II (Ang II) or arginine-vasopressin (AVP) at increasing concentrations between 10(-10)-10(-6) M with or without each calcium antagonist tested at 10(-6) M. At the end of the incubation period, the medium was aspirated, centrifuged, and assayed for its content of protein and of 6-keto-PGF1 alpha by radioimmunoassay. Ang II induced a 15-fold increase and AVP induced a fivefold increase of 6-keto-PGF1 alpha at 10(-6) M. None of the various calcium channel blockers tested showed a significant effect on this agonist-stimulated production of 6-keto-PGF1 alpha. Consequently, calcium-channel blockers with different chemical structure, although known to inhibit agonist-induced vasoconstriction, appear to preserve vasoconstrictor-induced production of prostacyclin, a potent vasodilator and an inhibitor of platelet aggregation.

6-Ketoprostaglandin F1 alpha↗

Organic calcium channel blockers generate the coexistence of two different types of action potentials in the same muscle membrane following chemical induction of excitability.

1. Following exposure to the sulfhydryl reagents known as alpha,beta-unsaturated carbonyl compounds, the ventroabdominal flexor muscles of the crustacean Atya lanipes, which are normally completely inexcitable, generate trains of overshooting calcium action potentials; the effects of organic calcium channel antagonists and potassium channel blockers on the chemically-induced trains of action potentials have been studied. 2. Verapamil and D600, at micromolar concentrations, elicit the appearance of slow, cardiac-like action potentials which coexist with the much faster chemically-induced calcium spikes, transforming the regular repetitive firing into a cyclic bursting pattern. 3. Bepridil (1 microM) decreases the frequency of firing of the action potentials, probably by increasing the threshold for the activation of a population of the chemically-induced calcium channels. 4. The potassium channel blockers, TEA (30-40 mM) and quinidine (100-200 microM), delayed the rate of repolarization of the chemically-induced action potentials; none of the potassium channel blockers, however, induced the appearance of repetitive spike activity.

Action Potentials↗

Calcium flow-independent actions of calcium channel blockers in toad urinary bladder.

A role for transmembrane calcium movement in vasopressin stimulation of its target cell has been postulated based on studies with calcium entry blockers such as verapamil. We examined the effect of three sets of structurally different calcium blockers--D600 (an analogue of verapamil), diltiazem, and nifedipine--on water flow in toad bladder. D600 (200 microM), diltiazem (200 microM), and nifedipine (60 microM) inhibited vasopressin-induced water flow but enhanced adenosine 3',5'-cyclic monophosphate (cAMP)-induced water flow, suggesting that the drugs inhibit cAMP generation in response to vasopressin but enhance the response to exogenous cAMP by inhibiting phosphodiesterase activity. In the case of vasopressin stimulation, inhibition of cAMP generation appears to be the overriding effect. This was confirmed by measurements of cAMP content and the protein kinase ratio (-cAMP/+cAMP), which were significantly lower in bladders receiving both D600 and vasopressin than in those receiving vasopressin alone. Furthermore the drugs inhibited activation of adenylate cyclase by vasopressin in cell homogenates and inhibited phosphodiesterase in both homogenates and membrane-free supernatants. Thus these "calcium channel blockers" can directly alter cAMP metabolism in settings where movement of calcium should be irrelevant. The close correlation between the biochemical and transport effects of these agents suggests that their effect on water flow may occur by a direct effect on cellular enzymes or the membranes in which they reside and not by altering local calcium concentrations.

3',5'-Cyclic-AMP Phosphodiesterases↗

Pharmacologic profile of the dihydropyrimidine calcium channel blockers SQ 32,547 and SQ 32,926 [correction of SQ 32,946].

SQ 32,926 and SQ 32,547, two dihydropyrimidine calcium channel blockers, were characterized as potent inhibitors of depolarization-induced contractions of isolated smooth muscle preparations. In rat aorta, the IC50 values were 5.5 nM for SQ 32,547 and 8.1 nM for SQ 32,926, values which compare favorably with that of 2.9 nM for nifedipine. The dihydropyrimidines were also tested in a model of stable angina: pacing-induced ischemia in dogs. Both SQ 32,547 and SQ 32,926 reduced the ST-segment elevation observed in vehicle-treated animals. No significant changes in hemodynamic status were detected, suggesting that a reduction in cardiac work secondary to afterload reduction was probably not a major contributor to the protective effects. Neither was increased coronary blood flow important for the antiischemic outcome because no significant effects of the dihydropyrimidines were observed on ischemic regional blood flow. SQ 32,547 was also studied in globally ischemic, isolated rat hearts. In this model, SQ 32,547 was protective because it significantly reduced contracture formation and lactate dehydrogenase (LDH) release. Washing out the effect of SQ 32,547 in isolated hearts and smooth muscles was difficult, presumably due to its lipophilicity. In the smooth muscle preparations, the effects of both nifedipine and SQ 32,926 were much more easily washed out. As with other calcium channel blockers, increasing the antiischemic effects of SQ 32,547 was associated with a higher cost in terms of cardiac function. In summary, the two novel dihydropyrimidines, SQ 32,547 and SQ 32,926 showed antiischemic properties in animal models.

Animals↗

ICI 206,970: a novel calcium channel blocker with eukalemic diuretic activity.

ICI 206,970 is a novel eukalemic diuretic from the aminomethylphenol pyrazine series which exhibited a calcium antagonist profile. The isolated rat aorta evaluation and dihydropyridine ligand [3H]-PN 200-110 binding studies demonstrated that ICI 206,970, like verapamil and nifedipine, inhibits vascular smooth muscle tone by inhibiting voltage-sensitive calcium channels. ICI 206,970 produced dose-related hypotensive, negative chronotropic, dromotropic, and coronary vasodilator responses after i.v. injection in anesthetized dogs. ICI 206,970, similar to calcium channel blockers and dissimilar to diuretics, produced an acute antihypertensive effect in spontaneously hypertensive rats (SHR), and significant protection against the development of myocardial hypertrophy in SHR after chronic oral treatment for 28 consecutive days. It is concluded that ICI 206,970 is a calcium channel blocker in addition to its novel eukalemic diuretic property.

Animals↗

Immunoprotective effect of a calcium channel blocker on macrophage antigen presentation function, major histocompatability class II antigen expression, and interleukin-1 synthesis after hemorrhage.

Hemorrhage induces a severe suppression of the immune system resulting in increased susceptibility to sepsis. Although studies indicate beneficial effects of calcium channel blockers on cell and organ functions after low-flow conditions, it remains unknown whether such agents have any effects on different immune responses after hemorrhage. To study this, C3H/HeN mice were bled to a mean blood pressure of 35 mm Hg and were maintained for 60 minutes, followed by resuscitation with their own shed blood and adequate fluid. The mice received either the water-soluble calcium channel blocker diltiazem (400 or 2400 micrograms/kg body weight) or saline solution (vehicle). Peritoneal macrophages were obtained by lavage 24 hours later. Antigen presentation was measured by coculturing peritoneal macrophages with the D10.G4.1 helper T-lymphocyte clone. Immune associated antigen (Ia) expression was determined by direct immunofluorescence. Interleukin (IL)-1, 6, and tumor necrosis factor-alpha (TNF) levels in peritoneal macrophage supernatants were measured by use of cytokine-specific cellular assays. Hemorrhage caused a significant decrease in peritoneal macrophage antigen presentation function, Ia expression, and IL-1 and IL-6 synthesis in the vehicle-treated group, whereas TNF levels were increased. However, both doses of diltiazem significantly improved peritoneal macrophage antigen presentation, Ia expression, and IL-1 synthesis. IL-6 synthesis was only increased with high doses of diltiazem, whereas both diltiazem doses decreased TNF production. These results indicate that the calcium channel blocker diltiazem can markedly improve macrophage functions after hemorrhage. The use of diltiazem might offer a new therapeutic modality in the treatment of immunosuppression and in decreasing the susceptibility to sepsis after hemorrhagic shock.

Animals↗

Effects of calcium channel blockers on the endothelial release of von Willebrand factor after exercise in healthy subjects.

Von Willebrand factor (vWF) is known to play a relevant role in the development of atherosclerotic lesions by promoting platelet adhesion to injured endothelial cells. An increase in cytosolic calcium has been shown to be associated with the in vitro release of vWF from endothelial cells. The aim of our investigation was to examine the effect of some calcium channel blockers on the release of vWF antigen (vWF:Ag) induced by exercise in two groups of eight healthy subjects during a randomized crossover study between placebo and calcium channel blockers. Placebo and verapamil (80 mg) or nicardipine (10 mg) were given orally at an interval of 2 weeks three times on the day before and once on the morning of the study day. Measurements of plasma vWF:Ag were made at rest and after a progressive maximal exercise on a cycloergometer. A significant increase in absolute values of vWF:Ag was observed after exercise in the subjects given a placebo in both verapamil (0.397 +/- 0.074 U/ml) and nicardipine (0.327 +/- 0.036 U/ml) groups, p less than 0.05. With use of verapamil the rise in vWF:Ag was blunted and not significant (0.123 +/- 0.081 U/ml) whereas a larger increase in vWF:Ag was found in the subjects given nicardipine in comparison with placebo (0.593 +/- 120 U/ml; p less than 0.05). No correlations were observed between exercise-induced changes in systolic or diastolic blood pressure, heart rate, blood lactate level, or pH and vWF:Ag changes in the subjects given a placebo or in those given calcium channel blockers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

High affinity binding of the calcium channel blocker, (+)-[methyl-3H]PN200-110(3HPN) in rat brain.

PN200-110 is a recently introduced 1,4-dihydropyridine which has been demonstrated to be a potent calcium channel blocker. 3HPN has been shown to bind in a specific saturable manner to P2 fractions obtained from brain homogenates from male Sprague-Dawley rats. 3HPN binding was found to be temperature-dependent. Specific 3HPN binding was maximal at 25 degrees C; binding decreased at 2 degrees C and 37 degrees C. The KD calculated from Scatchard analysis was 0.0943 +/- 0.0038 nM while the Bmax was found to be 109.1 +/- 2.3 fmol/mg protein. A concentration dependent inhibition of 3HPN binding by various cations was determined and found to be as follows: ZN2+ greater than La3+ greater than Rh3+, Al3+ greater than Co2+, Ni2+, Mn2+ greater than Ca2+, Mg2+ greater than Ba2+ greater than Sr2+. These results provide evidence for the existence of central high affinity dihydropyridine receptor sites in rat brain.

Animals↗

Postischemic mechanical and vascular dysfunction (myocardial "stunning" and microvascular "stunning") and the effects of calcium-channel blockers on ischemia/reperfusion injury.

The purpose of this review is to summarize current concepts regarding the sequelae of myocardial ischemia and reperfusion and the effects of calcium-channel blockers. This article will focus on three topics: (1) the phenomenon of postischemic myocardial dysfunction (myocardial "stunning"); (2) the phenomenon of postischemic vascular dysfunction (microvascular "stunning"); (3) the effects of calcium-channel blockers on myocardial ischemia and reperfusion injury.

Animals↗

Comparative effects of the N-methyl-D-aspartate antagonist MK-801 and the calcium channel blocker KB-2796 on neurologic and metabolic recovery after spinal cord ischemia.

NMDA receptor antagonists have been demonstrated to be neuroprotective in focal cerebral ischemia and are supposed to prevent neurotoxic intracellular calcium increase. Another mechanism of calcium influx during ischemia involves activation of voltage-activated calcium channels, although the efficacy of calcium channel blockers against ischemia-induced damage varies. The purpose of this study was to determine the contributions of the excitotoxic mechanism and of calcium channel activation to metabolic and functional damage to rabbit spinal cord after ischemia induced by occlusion of the abdominal aorta. All metabolic parameters determined (ATP, energy charge, and lactate) completely recovered at 4 days following 20 min of ischemia when NMDA receptor antagonist MK-801 (1 mg/kg given i.v.) or calcium channel blocker KB-2796 (50 mg/kg given i.p.) was administered either prior to or after ischemia. Significant metabolic recovery was also observed after 30 min of ischemia with MK-801 administered before occlusion and KB-2796 given early in recirculation. Similarly, neurologic functions followed by functional performance in the hindlimbs were completely recovered following 20 and 30 min of ischemia and 4 days of recovery. This study demonstrates that although MK-801 or KB-2796 does not prevent paraplegia due to spinal cord ischemia in the rabbit, both drugs can influence the rate of recovery after ischemic injury.

Adenosine Triphosphate↗