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Antianginal efficacy of gallopamil in comparison to nifedipine
1Medizinische Universitätsklinik, Lehrstuhl Innere Medizin III, Homburg/Saar, F.R.G.
Insights
Gallopamil effectively treats angina, prolonging exercise time and reducing ST depression. This antianginal drug demonstrated a superior safety profile compared to nifedipine in patients with chronic stable angina.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic stable angina affects numerous patients, necessitating effective antianginal therapies.
- Current treatments like nifedipine can have significant side effects, prompting research into alternatives.
Purpose of the Study:
- To compare the antianginal efficacy and safety of gallopamil versus nifedipine in patients with chronic stable angina.
- To evaluate the impact of these drugs on exercise tolerance and electrocardiographic markers of ischemia.
Main Methods:
- A randomized, double-blind, crossover trial involving 30 patients with chronic stable angina.
- Patients were initially treated with nifedipine (60 mg/day), then gallopamil (150 mg/day), and a reduced nifedipine dose (30 mg/day) was used in a second protocol due to adverse events.
Main Results:
- Gallopamil significantly prolonged exercise time to angina onset and total exercise time compared to placebo (P < 0.01).
- Both gallopamil and nifedipine reduced ST depression, with gallopamil showing a greater reduction (77% vs. 52%).
- Gallopamil exhibited a lower increase in heart rate and rate-pressure product, with fewer reported side effects than nifedipine.
Conclusions:
- Gallopamil is an effective antianginal agent for chronic stable angina.
- Gallopamil appears to have a superior therapeutic to toxic ratio compared to nifedipine.
Abstract:
In a randomized double-blind crossover trial 30 patients with chronic stable angina were studied to compare the antianginal actions of gallopamil (150 mg/day) and nifedipine. With the initial nifedipine dose of 60 mg/day, the trial had to be stopped because of severe exacerbation of angina in 3 patients of the nifedipine group. Twenty-one patients were entered into a second protocol with the nifedipine dose reduced to 30 mg/day. Compared to the preceding placebo period, the exercise time to onset of angina (+ 30%, P less than 0.01) and the total exercise time (+ 18%, P less than 0.01) were prolonged by gallopamil but not by nifedipine (+ 20 and 13%, respectively, not significant) with no significant difference between the test drugs. Four patients became free of angina during exercise testing with gallopamil therapy and one patient with nifedipine. Both agents significantly reduced ST depression at maximal comparable workload by 77% (gallopamil) and 52% (nifedipine) compared with placebo; the difference between the drugs reached borderline significance (P = 0.055). The increase in heart rate and the rate-pressure product at maximal comparable workload was less with gallopamil than with nifedipine (P less than 0.01). In contrast to nifedipine, very few side effects were reported with gallopamil. Thus, gallopamil is an effective antianginal agent whose therapeutic to toxic ratio appears to be superior to that of nifedipine.