Acute electrophysiologic effects of bethanidine sulfate in patients with ventricular tachycardia or fibrillation.

Ten patients with a history of ventricular tachycardia or ventricular fibrillation underwent electrophysiologic study with programmed stimulation before and 90 minutes after oral administration of bethanidine sulfate, 20 mg/kg. Mean plasma bethanidine concentration was 2.62 +/- 2.2 (+/- SD) micrograms/ml at the start of repeat testing. This dose of bethanidine produced no effect on sinus node function, atrioventricular conduction, or atrial or ventricular refractoriness. Ventricular tachycardia or fibrillation, inducible in all patients during the control study, could still be initiated by ventricular stimulation in 9 of 10 patients after bethanidine. Bethanidine suppressed the ability to initiate an arrhythmia in one patient with ventricular fibrillation during control stimulation. Orthostatic hypotension was seen in all patients despite pretreatment with the tricyclic antidepressant, protriptyline, 15 mg every 8 hours. The results suggest that bethanidine has few electrophysiologic effects and is of limited efficacy during electrophysiologic testing in patients with life-threatening ventricular arrhythmias.

Determination of bethanidine in plasma by liquid-chromatography with a microbore reversed-phase column.

In this novel method for quantifying bethanidine in plasma, after a multi-step extraction of bethanidine and internal standard from 2.0 mL of plasma, the drugs are separated on a "microbore" C18 reversed-phase column and quantified by their ultraviolet absorbance at 210 nm. The isocratic chromatographic separation takes about 15 min with use of an ion-pairing regent in the mobile phase (acetate buffer/acetonitrile, 9/1 by vol) and a flow rate of 0.25 mL/min. Sensitivity is increased relative to conventional columns, and solvent consumption is reduced by 90%. The standard curve is linear to at least 5 mg/L, and the detection limit is 0.02 mg/L. The within-run precision of the method is excellent (CV 4%) at a midrange concentration of 1.25 mg/L.

Antiarrhythmic, antifibrillatory, and hemodynamic actions of bethanidine sulfate: an orally effective analog of bretylium for suppression of ventricular tachyarrhythmias.

Bethanidine sulfate is a chemical and pharmacologic analog of bretylium tosylate that has virtually identical antifibrillatory and inotropic actions on the heart. Bretylium is the only drug approved by the Food and Drug Administration specifically for the "prophylaxis and treatment of ventricular fibrillation." Unlike bretylium, which is poorly absorbed from the gut and limited to parenteral use, oral bethanidine is absorbed rapidly. Bethanidine was given to 23 patients with recurrent multiple drug refractory ventricular tachycardia and fibrillation. Eighteen patients (78%) had complete suppression of spontaneous or electrophysiologically inducible tachyarrhythmias; 3 were improved and 2 had no benefit. In 6 of a 9 patient subgroup studied by programmed electrophysiologic drug testing, bethanidine completely prevented previously inducible ventricular tachyarrhythmias at the maximal stimulus tested (including 4 extrastimuli and burst-pacing at 10 times threshold). Cardiac output measured in 6 patients 1 to 2 hours after bethanidine was increased in 4, unchanged in 2, and decreased in 1. Ten patients on long-term therapy with bethanidine and protriptylene (to prevent orthostatic hypotension) have been free of arrhythmias from 2 to 26 (average 13) months.

Bethanidine elimination from plasma.

Bethanidine was administered intravenously to six hypertensive patients with normal renal function and five hypertensive patients with renal impairment. After administration of 0.7 mumole/kg, blood was sampled at frequent intervals for measurement of plasma bethanidine. The plasma levels were analyzed on a three-compartment exponential open-model system. The second rapid elimination phase (beta) had a half-time of 3.4 hours in normal subjects and was insignificantly prolonged to 16.4 hours in renal impairment. There was an extended terminal elimination phase of 90 and 70 hours for normals and impaired, respectfully. The volume of distribution at pseudoequilibrium was 2.8 and 1.6 liters/kg, respectively, suggesting significant sequestration of the drug in body tissues. The pharmacokinetic constants of bethanidine in normal and impaired renal functions were similar.

Bethanidine dose, plasma levels, and antihypertensive effects.

Bethanidine dose, plasma levels, and hypotensive effects were evaluated in twelve hypertensive patients. Diuretic therapy with benzthiazide was started two weeks before and continued during the study. Bethanidine was given three times daily. After two to 12 months of therapy in 11 of the patients, the mean standing diastolic pressure was reduced from 112 to 91 mm Hg. The mean total daily bethanidine dose was 79 mg (range 30--150 mg). The mean plasma bethanidine was 0.65 micrometer (range 0.1--2.8 micrometer), which correlated with the bethanidine dose. There was less correlation between dose and antihypertensive effect. The effects of sudden withdrawal from chronic bethanidine dosing were observed in six patients. The orthostatic effect of bethanidine was lost within 12 hours, but the half-time of elimination of bethanidine from plasma was 39 hours. Based upon the present findings, recommendations are presented for initiation and maintenance of antihypertensive therapy with bethanidine.

Fluorometric assay of bethanidine in plasma.

A fluorometric method for determining bethanidine in blood plasma is described. The bethanidine is extracted into chloroform, a drug-dye complex with eosin Y is formed, and the fluorescence is measured (excitation, 535 nm; fluorescence, 560 nm). The assay detects 0.02 muM bethanidine (4 ng/ml) in plasma. The relative fluorescence of several body constituents and antihypertensive drugs is negligible. The plasma levels of bethanidine in four hypertensive patients receiving this drug were measured.