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Effects of antihistamines and local anesthetics on excess tachycardia in conscious dogs.

Atropine produces cardioacceleration in conscious dogs partly by reversing the pre-existing parasympathetic cardioinhibition and partly by inducing "excess tachycardia" (ET). Because ET occurs independently of adrenergic mechanisms, the present study sought to determine whether ET is generated by a positive chronotropic action of endogenous histamine on pacemaker cell H1 receptors. ET was antagonized in conscious dogs by the H1-receptor antagonists pyrilamine, diphenhydramine, chlorpheniramine and promethazine (1-5 mg/kg i.v.), but not the H2-receptor antagonist cimetidine (2-10 mg/kg i.v.). Pyrilamine (0.1 mg/kg i.v.), but not cimetidine (4 mg/kg i.v.), also eliminated a histamine tachycardia (31 +/- 4.1 beats/min) produced by injecting histamine (22 +/- 14.2 micrograms) into the sinus node artery after pharmacological autonomic blockade. The 30-fold greater dose of pyrilamine required to antagonize ET than histamine tachycardia suggests a nonantihistaminic, and possibly a local anesthetic mechanism of action on ET. Indeed, lidocaine, procaine, propranolol and pyrilamine antagonized ET in doses corresponding to the known relative local anesthetic potencies of these agents. The same doses of pyrilamine, lidocaine and procaine had significantly less effects on a comparable beta adrenergic tachycardia produced by intravenous isoproterenol infusion (0.1-0.5 micrograms/kg/min i.v.) after hexamethonium (10 mg/kg i.v.). The results indicate that H1-receptor blockers antagonize ET because of their local anesthetic effects and not their antihistaminic properties. The results also suggest that the ionic pacemaker mechanisms generating ET and beta adrenergic tachycardia are different.

Anesthetics, Local↗

Anticonflict properties of the dipeptide Litoralon and of diazepam in rats.

The anticonflict properties of the anxiolytic diazepam and of the dipeptide Litoralon gamma-L-glutamyl-taurine and two of its analogues SZJ 3388, gamma-aminobutyryl-ethanolamine phosphate, and SZJ 3361, D-1-aminoisobutyrylethanolamine phosphate have been investigated in a "time-to-emerge" conflict paradigm in non-deprived rats. Diazepam, Litoralon and compound SZJ 3388 significantly decreased the "time-to-emerge" latency (TTE latency) in a dose-dependent manner versus saline- or vehicle-treated controls in doses between 0.05 and 0.50 mg/kg intraperitoneally. The analogue SZJ 3361 was inactive as regards the TTE latency, while the anti-histaminic promethazine lengthened the TTE latency in a dose-dependent manner. The number of irresolute responses was significantly decreased following administration of diazepam, SZJ 3388 and Litoralon and was positively correlated with the TEE latency-decreasing activity of these compounds. The data are discussed in terms of the benzodiazepine-like anxiolytic or anti-conflict properties of these dipeptides.

Animals↗

Effects of H1 antihistamines on canine nasal vascular and airway resistances.

The effects of three commonly used H1 antihistamines on the nasal vascular and airway resistances were studied in the dog. Promethazine hydrochloride decreased nasal vascular resistance but increased nasal airway resistance in a dose-dependent manner. Diphenylpyraline hydrochloride in low doses increased nasal vascular resistance without affecting much nasal airway resistance while in high doses decreased nasal vascular resistance but increased nasal airway resistance. Chlorpheniramine maleate in low doses increased nasal vascular resistance but decreased nasal airway resistance while in high doses decreased nasal vascular resistance without affecting much nasal airway resistance. It was concluded that different H1 antihistamines might exert vasoconstrictor or vasodilatatory action on both the resistance and capacitance vessels of the nasal vascular bed depending on the type and the dose of the drug used.

Airway Resistance↗

Increment of calmodulin in proportion to enhancement of non-nicotinic responses after preganglionic stimulation of the dog cardiac sympathetic ganglia.

The possible involvement of calmodulin in ganglionic function was investigated. Drugs were given directly into the cardiac sympathetic ganglia through the right subclavian artery (i.a.), unless otherwise stated. Positive chronotropic responses to angiotensin II (0.1 and 0.2 micrograms) were enhanced after repetitive high frequency preganglionic stimulation to the right stellate ganglion. After the stimulation, positive chronotropic responses to bethanechol (2.5, 5 and 10 micrograms), but not those to dimethylphenylpiperazinium (2.5, 5 and 10 micrograms), also were enhanced. The enhancement of response to angiotensin II was not affected by i.v. pretreatment with hexamethonium (40 mg/kg) plus atropine (1 mg/kg) or nifedipine (1 mg/kg). Responses to angiotensin II were not enhanced by A23187 (0.3 mg). The enhanced response to angiotensin II after the stimulation was reduced by the calmodulin antagonists, trifluoperazine (0.1, 0.2 and 0.4 mg) and by N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide (0.5, 1 and 2 mg), but not by promethazine (1 mg) and N-(6-aminohexyl)-1-naphthalenesulfonamide (0.5, 1 and 2 mg). The enhanced response to bethanechol after the stimulation also was inhibited by N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide. Pretreatment with N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide before the stimulation prevented development of the enhancement in responses to the peptide. The inhibition of endogenous protein synthesis by cycloheximide, 2.5 or 5 mg/kg i.v. 6 hr before surgical procedures, strongly inhibited development of the enhancement in responses to angiotensin II.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin II↗

Pharmacological interventions for motion sickness: cardiovascular effects.

Motion sickness (MS) was provoked in healthy volunteers subjected to simultaneous rotation through the vertical axis with head movements (HM). Arterial blood pressure (BP), heart rate (HR) and forearm blood flows (BF) were intermittently monitored. Forearm BF was measured by venous occluding plethysmography. Rotation at 20 rpm and cyclic HM were continued for 10 min or until the subject requested cessation of HM because of imminent emesis. There were no consistent changes in BP or HR, but marked increases in BF were observed with MS. There was an inverse correlation between duration of HM tolerance and increments in BF. Antimotion sickness medications scopolamine:d-amphetamine (0.4:5.0 mg) or promethazine:ephedrine (25:60 mg) failed to significantly increase the duration of HM; the latter mixture, however, did significantly reduce the HM-induced-hyperemic responses. Administration of naproxyn (275 or 550 mg) did not significantly alter HM duration or BF responses. These studies suggest that BF changes may be an objective index of MS susceptibility.

Adult↗

Mechanism of the central hyperglycemic action of histamine in mice.

The effect of i.c.v. administration of histamine (HA) on the plasma glucose level was examined in mice. HA (0.09-180 nmol) increased dose-dependently the plasma glucose level, 30 min after the injection. Even a low dose of 0.45 nmol produced a significant effect. The pretreatment with metoprine, an inhibitor of HA-N-methyltransferase, heightened the peak of the hyperglycemic response markedly and prolonged the duration. Systemic administration of the H1-receptor antagonists mepyramine (0.5-2 mg/kg), chlorpheniramine (1-4 mg/kg) and promethazine (1-4 mg/kg), inhibited dose-dependently the HA-induced hyperglycemia, whereas an H2-receptor antagonist, cimetidine (80 nmol i.c.v.), was without effect. The hyperglycemic response to HA disappeared in bilaterally adrenalectomized mice. Although the treatment of mice with metyrapone reduced the plasma corticosterone level to less than 15% of the control value, the hyperglycemic response to HA was still observed. After the administration of HA, there was a significant elevation of plasma norepinephrine levels. Increase in the plasma epinephrine was more marked than the norepinephrine response. Pretreatment with phentolamine (5 mg/kg i.p.) but not propranolol (15 mg/kg i.p.) inhibited the HA-induced hyperglycemia by about 50% and the combination of same doses of phentolamine and propranolol blocked the response completely. These results suggest that the central hyperglycemic effect of HA is produced mainly by an increase in the sympathetic outflow, followed by an increase in catecholamine secretion from the adrenal medulla. It is likely that the stimulation of H1, but not H2, receptors in the brain is involved in this response.

Adrenalectomy↗

[Midazolam and pethidine/promethazine for intramuscular premedication].

The main reason for premedication is the reduction of preoperative stress. Despite the proven fact that benzodiazepines best reduce preoperative stress, combinations of opioids and neuroleptic drugs are preferred for premedication by many on reviewing the journal Der Anaesthesist. This double-blind study was performed to investigate midazolam and meperidine/promethazine for intramuscular premedication. Method. 60 patients undergoing minor gynecological surgery were randomly assigned to receive either 5-7.5 mg midazolam or 50-75 mg meperidine and 25-50 mg promethazine intramuscularly 30-90 min before surgery. Anxiety, depression, and asthenia were assessed by the patient before and after premedication but before induction of anesthesia using visual analogue scales and a nominal scale. Sedation was assessed by an observer. Heart rate and blood pressure were the physiological stress parameters. Parameters of acceptance and side effects were registered perioperatively. Results. Midazolam had a significantly better anxiolytic and antidepressive effect. There were no differences in the other parameters except for adverse effects. Meperidine/promethazine produced significantly more side-effects than midazolam. The parameters of acceptance assessed the day after surgery were comparable. Conclusions. We conclude from these results that anesthesiologists still premedicate with meperidine/promethazine because the patients accept this premedication very well when asked the day after surgery. Nevertheless, premedication with midazolam provides significantly better anxiolytic and antidepressive effects with significantly less side-effects. Therefore, midazolam should be preferred to meperidine/promethazine for intramuscular premedication.

Adolescent↗

Comparison of intramuscular injection techniques to reduce site discomfort and lesions.

The Z-track intramuscular injection technique was compared with the standard injection technique for incidence and severity of discomfort and lesions at the injection site. Fifty subjects received injections of meperidine hydrochloride alone or in combination with promethazine hydrochloride every 3 to 4 hours for a total of two to eight injections. Subjects served as their own controls by receiving both techniques. They were evaluated for the presence and severity of discomfort on a 4-point Likert scale. Injection site lesions were determined by visualization and palpation. The Z-track technique significantly decreased incidence of selected descriptors of discomfort and lesions at selected time intervals, severity of discomfort at selected time intervals, and severity of lesions at all time intervals postinjection.

Adult↗

Phenothiazine analgesia--fact or fantasy?

Double-blind clinical trials involving the use of phenothiazines as analgesics or potentiators of analgesics (aspirin, meperidine, morphine sulfate) and adverse effects of phenothiazines are reviewed and evaluated. Promethazine, promazine and propiomazine were not found to possess analgesic or potentiating properties. One chlorpromazine study contained important design and reporting deficiencies which precluded a recommendation for use of chlorpromazine in the treatment of pain. Methotrimeprazine was determined by numerous authors to have analgesic properties; however, most of the studies also were deficient in design or data presented, or both. Adverse reactions to phenothiazines, including hypotension, sedation, drowsiness, extrapyramidal symptoms, tardive dyskinesia, cardiac toxicity and agranulocytosis, are often more common and severe than those attributed to narcotic analgesics. Because of the lack of data supportive of analgesic activity and the adverse reactions associated with phenothiazines, use of these agents in the management of pain should be discouraged. The prophylactic use of phenothiazine for narcotic analgesic-induced emesis also is, in most cases, a questionable practice.

Analgesics↗

A theoretical study of the binding of phenothiazine derivatives to residues 82-93 of calmodulin.

A theoretical study was performed of the interaction of four phenothiazine derivatives, promethazine, promazine, trifluopromazine, and trifluoperazine, with a fragment (82-93) of calmodulin, held in the alpha-helical conformation. The computations were performed in the framework of the SIBFA 2 procedure (sum of interactions between fragments computed ab initio), which uses analytical formulas based on ab initio self-consistent field computations. The interaction energy is the sum of the intermolecular phenothiazine-oligopeptide interaction energy and of the separate intramolecular energy variations of the phenothiazine and of the side chains of the oligopeptide upon complex formation. The ordering of interaction energies of the four investigated phenothiazines parallels the ordering of their experimentally measured affinities for calmodulin, with a maximum affinity for trifluoperazine. The principal features of the trifluoperazine complex are a short hydrogen bond between the piperazinium proton and one anionic oxygen of Glu 87, and hydrophobic interactions between the piperazinium ring and Val 91 and between the methylene chain and Ala 88, together with partial insertion of the phenothiazine ring and the--CF3 substituent between Phe 89 and Phe 92.

Calmodulin↗

Taste preference for cough syrups: a comparative study of three codeine-containing medications.

Unpleasant taste is a common feature of cough syrups, particularly those containing codeine. An antitussive compound of codeine sulfate and chlorpheniramine maleate was formulated in a coated drug-resin complex, which prevents release of the active ingredients until they reach the stomach and small intestine. Thus patients do not taste the bitterness of the codeine. A three-way crossover taste test was conducted in 175 volunteers who tasted each of three cough syrups in random sequence, rated the taste of each, and ranked their preferences. The cough syrups used in the study were the aforementioned formulation (CM), promethazine hydrochloride with codeine (PH), and iodinated glycerol with codeine phosphate (IG). Tastes were rated on a scale from +2 (very good) to -2 (very poor). Mean rating scores for each product were 0.97 for CM, 0.14 for PH, and -1.5 for IG. Pairwise comparisons showed statistically significant differences between CM and PH (P less than 0.01) and CM and IG (P less than 0.001) but no significant difference between PH and IG. CM was ranked as most liked by 115 respondents and as least liked by 27 respondents. Reasons cited for this preference were its sweet rather than medicinal taste and its smooth, thick consistency. Bitterness was a common reason for the lack of preference for PH and IG. CM thus was shown to have greater user acceptability than either of the other two cough syrups tested.

Antitussive Agents↗

Pesticide-drug interaction in rats.

The possible interactions between a fungicide, thiram, and some drugs acting on the central nervous system were investigated in rats by means of behavioral methods. Potentiation was found after combined treatment with thiram and promethazine, and after thiram and meprobamate. In the case of trihexyphenidyl, an additive interaction was observed. It is presumed that these observations will be of practical toxicological significance.

Animals↗

[A comparison of two preoperative medications: responses in sedative, psychic and somatic effects (author's transl)].

The influence of two different premedication methods on the psychic reaction of the patient and their somatic-vegetative effect was tested in a controlled double-blind study. 96 patients between the ages of 20 and 40 took part in the study and were divided into two groups. Group 1 (n = 47) received meperidine (Alodan) and promethazine (Phenergan). Group 2 (n = 49) were given thalamonal. All patients underwent a personality test (Cattell 16 PF) a day prior to scheduled surgery. After administration of the respective pre-anaesthetic drugs, three different test methods were applied to determine their subjective state. Simultaneously, independent from the patients, their psychic reactions were determined by the anaesthetist. Premedication 2 effected less calm, i.e. decrease of fear, exhaustion and depression, than premedication 1. The somatic-vegetative region exhibited no significant difference except for increased cardiocirculatory symptoms in group 1. Based on the less favourable psychodynamics in patients who received thalamonal, it is not advised as pre-anaesthetic medication.

Adult↗

[Mechanism of action of certain fibrinolytic bis-tetrahydroisoquinolines: their antagonists and histamine- and 5-hydroxytryptamine-releasing effects (author's transl)].

1, 1'-Heptamethylene-bis-6, 7-dimethoxy-1, 2, 3, 4-tetrahydroisoquinoline (HBDT) and 1, 1'-tetramethylene-bis-6, 7-dimethoxy-1, 2, 3, 4-tetrahydroisoquinoline (bisobrin) produced an edema when given subcutaneously into the hind paws of rats. The inhibitory effects of various antagonists on the paw edema and fibrinolysis induced by HBDT were examined in rats to determine whether chemical mediators other than histamine were involved. The relation of histamine to the fibrinolytic activity of these bis-tetrahydroisoquinoline derivatives has already been reported. Both edema and fibrinolysis were significantly inhibited by pretreatment with promethazine, cyproheptadine or phentolamine, but not by dibenamine, propranolol, atropine, indomethacin or pyridinolcarbamate. epsilon-Aminocaproic acid inhibited the fibrinolytic activity completely without any effect on the paw edema. HBDT released 5-hydroxytryptamine (5-HT) along with histamine from rat peritoneal mast cells. However, the amount of released 5-HT was considerably smaller than that of histamine. These results suggested that bis-tetrahydroisoquinolines released both histamine and 5-HT and that these mediators produced paw edema and induced fibrinolysis by enhancement of plasmin production.

Animals↗

[Sudeck's syndrome (author's transl)].

Though being not frequently seen now Sudeck's syndrome is still an undesirable painful complication of the healing and functional restitution in cases of injury to the wrist joint area. It is clear now that Sudeck's syndrome cannot be prevented only by correct surgical procedure, but that it is conditioned situationally and by the vegetative lability of the injured individual's personality and predisposed in this way. Besides routine rehabilitation the indication includes medication acting on the vegetative nervous system. Good healing conditions are obtained with a Chlorpromazine-Promethazine-Dihydroergotoxin combination for 6 to 8 weeks, blockade of the stellate ganglion and sufficient patience and consideration shown to the mentally upset and depressively reacting patient.

Chlorpromazine↗

Granule fusion and fission (discharge) are biochemically dissociable events of exocytotic hormone release.

Granule fusion and the subsequent fission leading to hormone discharge are distinct and separable events in exocytosis. As an index of fusion, we followed the recruitment of granule-bound somatostatin receptors to the islet surface, an event which accompanies secretion vesicle migration and insulin secretion. Granule fission was monitored by measuring insulin release. Substitution of the impermeant salt sodium isethionate for NaCl led to a 90% decrease in glucose-stimulated insulin release with no inhibition of somatostatin receptor recruitment. The phenothiazine drugs, trifluoperazine and promethazine, believed to inhibit calcium-sensitive proteins involved with stimulus-secretion coupling blocked insulin release and somatostatin receptor recruitment in parallel. This suggests that these agents suppress intracellular events promoting fusion of the secretion granule with the plasma membrane. IBMX appears to stimulate specifically granule fission since IBMX-induced insulin release occurs acutely without an increase in somatostatin receptor recruitment. Sodium isethionate, which inhibits granule lysis, blocked IBMX-stimulated insulin release.

1-Methyl-3-isobutylxanthine↗

[Early pulmonary lesions from hyperoxia in rats].

Normal rats exposed during one hour to pure normobaric oxygen, present pulmonary parenchymatous lesions: diffuse congestion, subpleural atelectasis in dissiminated small areas and hemorragic infarcts. Neither alveolar oedema nor abnormal vascular permeability have been observed. The lesions are not suppressed by pretreatment with promethazine (1 or 2 mg. 100 g-1).

Animals↗