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PubMedDate not supplied

Bretylium tosylate--induced stabilization of electrical systole duration in patients with acute myocardial infarction.

The electrical systole duration (QTc), heart rate, and the QTc/QTt ratio were studied during the hospital course of an uncomplicated AMI in 13 patients treated with bretylium tosylate (10 mg/mg/24 hr over 5 days since confirmation of AMI) and in 19 controls. The QTc/QTt ratio showed prolongation of electrical systole duration in control subjects with a maximal value at the second day after AMI. QTc increased in these patients from day 1 to day 2 after AMI (402 +/- 4 msec vs. 430 +/- 3 msec, p less than 0.05) and decreased in the following days (p less than 0.05). During hospitalization cardiac rate was constant in both groups. In contrast, patients treated with bretylium tosylate showed a stable duration of QTc and the QTc/QTt ratio did not indicate prolongation of electrical systole duration. After drug discontinuation a slight increase in QTc duration was noticed (391 +/- 6 msec vs. 413 +/- 5 msec, p less than 0.05). These observations may contribute to the understanding of the antiarrhythmic action of bretylium and would indicate its usefullness in AMI patients with prolonged QTc and high risk of life-threatening arrhythmias.

Adult↗
PubMed1981

Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy. Report of two cases.

Two patients were treated with bretylium tosylate for malignant ventricular arrhythmias after inadequate response to conventional agents. In the first patient, two episodes of ventricular tachycardia requiring cardioversion occurred in close temporal sequence with administering bretylium. With drug rechallenge two days later, ventricular tachycardia recurred within minutes. In the second case, five cardiac arrests due to ventricular tachycardia and fibrillation occurred during several hours after beginning a trial of bretylium maintenance therapy for complex ventricular ectopy. Although transient increases in ectopy after bretylium therapy have been described, presumably due to catecholamine release, the occurrence of life-threatening ventricular arrhythmia leading to cardiac arrest has not previously been emphasized. There is potential for this side effect, and additional caution in the use of this drug should be followed.

Adult↗
PubMed1980

Bretylium tosylate intravenous admixture compatibility. I: Stability in common large-volume parenteral solutions.

The stability of bretylium tosylate in 11 common large-volume parenteral solutions was studied. Two containers of each solution, one glass and one plastic (except for mannitol and sodium bicarbonate solutions, which were available in glass only), were stored at each of the following conditions: intense light (1400-2000 foot candles), ambient room temperature with normal light, 40 degrees C, and 4 degrees C. All samples were tested at 0 and 24 hours; some samples were also tested at 48 hours and 7 days. Testing included measurement for optical density at 4000 and 600 nm, pH level, and bretylium content as determined by HPLC. The admixtures remained clear and colorless, except that mannitol precipitated out of mannitol solutions stored at 4 degrees C. No appreciable changes in pH were observed. HPLC assays showed no significant changes in bretylium tosylate concentrations. Bretylium tosylate is compatible with each of the 11 common intravenous solutions chosen for investigation under the storage conditions studied. Admixtures with mannitol should not be refrigerated, because mannitol crystallizes from solution at refrigerator temperatures.

Bretylium Compounds↗
PubMed1976

[Clinical experiences with bretylium tosylate].

Because of its antiarrhythmic and antifibrillatory qualities as well as its positively inotropic effect bretylium tosylate increasingly finds interest. The first results of a clinical and haemodynamical mechanocardiographic investigation with bretylium tosylate are presented. In doses between 1.6 and 6.2 mg/kg body weight intravenously and intramuscularly after an initial increase of blood pressure a clear decrease of the systolic system blood pressure develops. The resistance of the peripheral vessels decreases by 10 to 20%. It is an increase of the heart index and the stroke volume index by 10 to 30% to be proved as an expression of a positively inotropic effect. In orientating investigations the antiarrhythmic effect could be confirmed. The side-effects observed cause us to give a strong indication and to observe the patients carefully. The main area of application of bretylium tosylate might be seen in the possibility to achieve a pharmacological defibrillation of the ventricles.

Adult↗
PubMed1976

[Bretylium tosylate as an anti-arrhythmic drug].

With the help of an analysis of the world literature pharmacological, pharmacokinetic and electrophysiological properties as well as the possibilities of the clinico-therapeutic use of Bretylium tosylat are demonstrated. The pharmacon is of increasing interest as antiarrhytmic, especially in the commandment of otherwise therapy-refractory ventricular disturbances of rhythm. A positively inotropic effect is proved. More severe side effects, such as arterial hypotension and increase of the pulmonary vascular resistance have an objection to routine application. The antifibrillatory effect needs particular consideration. This effect might promote this pharmacon to the "chemical defibrillator" in the emergency situation.

Animals↗
PubMed1976

[Study of the electrophysiological properties of bretylium tosylate in man].

The electrophysiological changes induced by bretylium tosylate have been studied in 22 patients during the 45 minutes following the intra-atrial injection of the drug at the dose of 5 mg/kg. The potential in the bundle of His was measured, and the stimulus-test method used to determine the refractory period. The results were subjected to Student's test. The sinus rate increased after bretylium. The A-V nodal conduction time (A-H interval) and infra hisian conduction time (HV interval), evaluated at the same imposed frequency, were not affected. The functional refractory period of the A-Vnode was decreased. The relative refractory period of the His-Purkinje system was increased. Finally, the right auricle showed an increase in its effective refractory period, while that of the ventricle remained unchanged. This study suggests that the electrophysiological effects of bretylium are due both to direct action at the cellular level and to sympathetic activity.

Action Potentials↗
PubMed1977

Effects of bretylium tosylate on the in vivo fibrillating canine ventricle.

Chemical ventricular defibrillation of the heart by intravenous or intracardiac administration of bretylium tosylate (6 to 24 mg/kg of body weight) did not occur in any dog (n = 30) given the drug 5 minutes before, immediately after, or 75 seconds after electrical induction of ventricular fibrillation. The bretylium did not appear to stabilize ventricular irritability nor facilitate resuscitation by electrical defribrillation when compared with the control group of dogs. Significant dose-dependent chronotropic or systemic pressure effects were not seen following bretylium administration.

Animals↗
PubMed1976

Quinidine syncope. A report of successful treatment with bretylium tosylate.

Quinidine syncope is an unpredictable side effect of quinidine administrateion which has a mortality rate of 11.5 per cent when managed with conventional drugs and direct-current countershock. In 2 patients with quindine syncope, the arrhythmias were effectively controlled within 30 minutes following the slow infusion of 150 mg. of bretylium tosylate. This control is contrasted with 2 cases managed in the conventional manner. Bretylium tosylate is a quaternary amine with unique antifibrillatory properties and appears to have a significant role in the management of these arrhylmias.

Adult↗