Hemodynamic effects of bepridil in patients with coronary artery disease

Bepridil is a calcium antagonist with a unique chemical structure and properties that differ from other calcium antagonists (e.g., a long half-life, sodium channel inhibition). In patients with normal left ventricular function, intravenous bepridil produces modest and short-lived reductions in heart rate and blood pressure. A transient negative inotropic effect is associated with higher doses (3-4 mg/kg). At the highest recommended oral dosage (400 mg/day), bepridil decreases resting heart rate and blood pressure; maximal exercise double product is not significantly reduced. In patients with impaired left ventricular function who are receiving oral bepridil 400 mg/day, virtually no distinguishable effects on heart rate, mean arterial pressure, pulmonary artery diastolic pressure or systemic vascular resistance were observed compared with placebo treatment. In patients with coronary disease, bepridil improves exercise hemodynamics (i.e., stroke volume index, cardiac index, ejection fraction) and reduces the frequency of wall motion abnormalities compared with placebo. Scintigraphic studies performed during stress suggest that compared with placebo, bepridil improves myocardial perfusion.