Prevention of adriamycin-induced cardiotoxicity by prenylamine: a pilot double blind study.

Adriamycin (ADM) is an effective antineoplastic drug. However, the amount of ADM that can be administered must be limited because of the risk of developing a severe dose-dependent myocardiopathy. Prenylamine (PNL), a calcium antagonistic drug, provided partial protection against ADM-induced cardiotoxicity in mice and in the rabbit. Thus, it was considered important to evaluate the cardioprotective potential of PNL in patients given ordinary doses of ADM. Twenty-six patients were selected and randomized in two groups, and a double-blind trial was begun. Group A (n = 13): patients received ADM, i.v. at standard oncological doses up to 550 mg/m2, plus placebo, orally. Group B (n = 13): ADM was administered as in Group A, but PNL 200 mg/day was given instead of placebo. Standard ECG and chest radiographs were performed at the beginning of treatment and every two months. Mode-M echocardiograms and 24-hour ambulatory ECGs were obtained previously to the beginning of the ADM treatment and two months after the administration of the last dose of the drug. In Group A, three patients died from oncological causes, total ADM dose was 359 +/- 100 mg/m2, and the mean age was 59.7 years. One patient in this group developed a congestive myocardiopathy while another patient developed a severe supraventricular arrhythmia. In Group B, four patients died from oncological causes, total ADM dose was 367 +/- 132 mg/m2, and the mean age was 63.8 years. No myocardiopathy was found in this group. These findings suggest that simultaneous administration of PNL may mitigate ADM cardiotoxicity, but larger trials are needed to draw definite conclusions.

Long term-treatment of ventricular tachycardia in ambulatory patients with amiodarone.

The antiarrhythmic effects of amiodarone hydrochloride 200 to 600 mg/daily were studied in 25 patients with ventricular tachycardia (VT). The arrhythmia was registered on a 24 hours two channel Holter recording. This study was performed before and after one month treatment with the drug. The adequate suppression of the VT was observed in 25 patients. The drug showed a total suppression of ventricular ectopic activity in 10 patients (40%) (4 at a dose of 200 mg/daily, 5 at 400 mg/daily and 1 at 600 mg/daily) and a satisfactory reduction (total suppression of couplets and VT and more than 85% reduction of premature ventricular beat frequency) in 12 patients (48%) (6 at a dose of 200 mg/daily, 5 at a dose of 400 mg/daily and 1 at a dose of 600 mg/daily). After a mean follow up of 15.9 months on continuous amiodarone therapy there have been no recurrences of arrhythmia on Holter recordings. No patient died during the study. Side effects were minimal and limited to corneal microdeposits at slit lamp examination without impairment of visual acuity. According to our results amiodarone is an excellent and safe agent for the treatment of complex ventricular arrhythmias.