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Nicardipine for angina pectoris at rest and coronary arterial spasm
Abstract:
The antiischemic effects and safety of nicardipine were assessed in 17 patients with angina at rest and coronary arterial spasm in a randomized placebo-controlled study over 8 to 13 weeks. Eleven patients had previously had unsatisfactory results with long-acting nitrates or other calcium blockers. The average daily dosage of nicardipine for optimal angina relief was 89 mg (range 40 to 160). During the double-blind phase, angina frequency decreased with nicardipine compared with placebo (mean 0.47 vs 2.11 attacks/day, p less than 0.05). A similar decrease in nitroglycerin requirements occurred (0.51 vs 2.77 tablets/day, p less than 0.05). During placebo periods, 51 episodes of ischemic ST-segment shifts occurred during 482 hours of ambulatory electrocardiographic monitoring and 12 (24%) were associated with angina. During nicardipine treatment, only 15 episodes of ST-segment shifts occurred during 498 hours of monitoring. In 1 patient a burning skin rash developed; otherwise, the drug was generally well tolerated. Thus, nicardipine is effective and safe in preventing symptomatic and asymptomatic ischemia in patients with coronary spasm. It may be particularly beneficial in patients with unsatisfactory responses to other therapy.
Insights
Nicardipine effectively reduces angina attacks and nitroglycerin use in patients with coronary artery spasm. This calcium channel blocker is safe and beneficial, especially for those unresponsive to other treatments.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery spasm can cause angina at rest.
- Existing treatments like nitrates and other calcium channel blockers may be insufficient for some patients.
Purpose of the Study:
- To evaluate the anti-ischemic effects and safety of nicardipine in patients with angina at rest and coronary artery spasm.
- To assess nicardipine's efficacy in patients with prior unsatisfactory treatment responses.
Main Methods:
- A randomized, placebo-controlled study involving 17 patients over 8-13 weeks.
- Ambulatory electrocardiographic monitoring was used to track ischemic events.
- Patients received varying daily dosages of nicardipine (40-160 mg).
Main Results:
- Nicardipine significantly decreased angina frequency (0.47 vs 2.11 attacks/day) and nitroglycerin use (0.51 vs 2.77 tablets/day) compared to placebo (p < 0.05).
- Ischemic ST-segment shifts reduced from 51 episodes during placebo to 15 during nicardipine treatment.
- Nicardipine was generally well tolerated, with one case of skin rash.
Conclusions:
- Nicardipine is an effective and safe treatment for both symptomatic and asymptomatic ischemia in patients with coronary artery spasm.
- The drug shows particular promise for patients who have not responded well to other therapies.