PubMed Health⌕ Search

Biomedical subjects

H J Gilfrich

Publications and source records attributed to H J Gilfrich.

At least 19 recordsLinked to original sources
PubMed1992

[Thrombocytopenia in digitoxin poisoning].

Because she felt unwell, an 80-year-old woman who was receiving treatment with digitoxin (0.07 mg daily) raised the dose on her own initiative to twice or three times the previous level. She then experienced faintness, visual abnormalities and bradyarrhythmia (rate about 40/min). The ECG showed 2 degrees AV block. The digitoxin level was 70.8 ng/ml--far above the upper limit of the therapeutic range (7.5-25 ng/ml). One striking abnormality was thrombocytopenia (33,000/microliters), though the white and red cell counts were normal. Petechiae were not present and there was no evidence of internal bleeding. As the AV block had not produced any critical fall in ventricular rate, there was no need to start treatment with digitalis-binding antibody fragments (Fab fragments). Instead, the patient was given cholestyramine 4 g three times daily with the aim of interrupting the enterohepatic circulation of digitoxin. From then on the rise in platelet count paralleled the fall in digitoxin level. Seven days after discontinuing digitoxin the platelet count reentered the normal range (147,000/microliters). However, the digitoxin level (39.5 mg/ml) was still well above the therapeutic range.

Aged↗
PubMed1991

[Tolerance of enoximone in patients with heart failure].

Enoximone, a new phosphodiesterase-inhibitor with positive inotropic and vasodilating activities is available for intravenous use in patients with severe heart failure. A review of the current knowledge regarding the adverse effects of this substance reveals that they are characterized by cardiovascular, central nervous, and gastrointestinal side effects. Adverse effects occurred in 20% of patients and were mostly due to the pharmacological properties of enoximone. Cardiovascular side effects (10%) were the most frequent; ventricular and supraventricular arrhythmias were most common. Two to three percent of the patients experienced hypotension due to the vasodilator activity of enoximone. Headache, insomnia, and anxiety were the most frequent adverse effects on the central nervous system. Three percent of the patients treated experienced vomiting, nausea, abdominal pain, and diarrhea. An increase of liver enzymes and serum glucose could be observed, mostly in patients with previous liver disease or diabetes. Pharmacokinetic drug interactions are not known; possible pharmacodynamic interactions result from the pharmacological properties of the drugs. Intravenous therapy with enoximone causes a few serious side effects that can only be controlled by careful observation of the patients treated.

Cardiotonic Agents↗
PubMed1989

Chronic therapy of severe heart failure with enoximone.

Clinical trials in patients with congestive heart failure have shown a wide disparity in the hemodynamic responses to chronic therapy with newer positive inotropic drugs. Therefore, the long-term efficacy of enoximone was studied in 10 patients with severe congestive heart failure. Patients were evaluated clinically, left ventricular dimensions and contractile state were assessed by echocardiography, and exercise testing was performed at basic conditions and after 1 and 8 weeks of enoximone treatment with a daily dose between 150-300 mg. Previous therapy of heart failure was continued during the study period. Clinical symptoms of eight patients were improved after 1 week and six patients showed sustained improvement after 8 weeks of enoximone treatment. The administration of enoximone increased ejection fraction by about 25% after 1 week with a similar response after 8 weeks. Five of six patients who were able to perform exercise testing initially experienced an increased exercise capacity over the study period. The enoximone regimen was continued in the responders; after 1 year, data on three patients are available and show sustained efficacy of enoximone treatment in two patients. The administration of the drug was well tolerated without any deterioration of arrhythmias. There is evidence that oral enoximone treatment may be useful as additional therapy in patients with severe heart failure.

Aged↗
PubMed1987

Comparison of AQ-A 39 with propanolol and placebo in ischaemic heart disease.

In a randomized, controlled study 10 male patients with angiographically confirmed ischaemic heart disease received AQ-A 39 (falipamil), a heart rate reducing agent in a single intravenous dose (2 mg kg-1) in comparison to propranolol (0.1 mg kg-1). Both drugs reduced heart rate in supine position slightly. The rise of heart rate induced by orthostasis was diminished by AQ-A 39 to 4 +/- 2 beats min-1 and by propranolol 9 +/- 2 beats min-1. After submaximal exercise heart rate during placebo was 129 +/- 3, during AQ-A 39 113 +/- 3 and during propranolol 103 +/- beats min-1. Systolic arterial pressure decreased by propranolol only. The double product obtained by placebo was 231 +/- 10 while it was for 194 +/- 9 after AQ-A 39 and 158 +/- 6 mmHg min-1 after propranolol, respectively. Both substances increased exercise time as compared to placebo. Furthermore, AQ-A 39 increased noradrenaline plasma levels in the upright position and after submaximal exercise compared to the values obtained following placebo. The dose of isoproterenol necessary to induce an increase of heart rate by 20 beats min-1 was after AQ-A 39 4.2 times greater and following propranolol 9.2 times greater than during placebo. The results suggest that AQ-A 39 will be useful in the short term management of patients with ischaemic heart disease.

Anti-Arrhythmia Agents↗
PubMed1979

[Biological availability of digoxin and beta-acetyldigoxin after single-dose administration (author's transl)].

The biological availability of digoxin tablets (Lanicor) and beta-acetyldigoxin tablets (Novodigal) was tested after single-dose administration. Plasma levels over 48 hours, the area under the blood-level curves and the cumulative urinary excretion over seven days served as a measure of biological availability. The area under the blood-level curve after 1.0 mg digoxin by mouth was 40.7 +/- 1.7 ng . ml-1 . h and after 1.0 mg beta-acetyldigoxin by mouth 39.1 +/- 1.4 ng . ml-1 h, compared with 56.1 +/- 1.4 after 1.0 mg digoxin intravenously. Seven days later 0.67 +/- 0.12 mg digoxin of the orally administered digoxin, 0.68 +/- 0.12 mg digoxin of the orally administered beta-acetyldigoxin and 0.81 +/- 0.08 mg of the intravenously administered digoxin were excreted in the urine. There was no significant difference in the biological availability of the two drugs (P greater than 0.05).

Acetyldigoxins↗
PubMed1979

[Plasma levels, renal excretion and metabolism of orciprenaline after administration in sustained-release form (author's transl)].

A newly developed sustained-release form of orciprenaline-sulfate (Alupent) was tested in 13 patients. Determination of 3H-radioactivity in blood, urine and faeces was used to elucidate its pharmacokinetic properties. Maximum plasma levels of radioactivity were obtained between 8 and 12 h after administration. 10.7 +/- 2.5% of the administered radioactivity were excreted in urine over a period of 72 h. Orciprenaline was mainly excreted as the sulfate-conjugate. Approximately five percent of the radioactivity were excreted as 4,6,8-trihydroxy-N-isopropyl-tetrahydroisoquinoline--the condensation product of formaldehyde and orciprenaline.

Biotransformation↗
PubMed1979

Pharmacokinetics of azapropazone following single oral and intravenous doses.

The pharmacokinetics of azapropazone (Prolixan) was studied in 7 healthy volunters following single oral and i.v. doses of 600 mg. After i.v. injection plasma concentration declined biexponentially with time. The half-life of the beta-phase was 13.6 +/- 2.6 h (mean +/- SD), the apparent volume of distribution 11.9 +/- 3.5 l, and the total clearance 10.1 +/- 2.1 ml . min-1. Following oral administration peak plasma concentrations occurred between 3 and 6 h and declined with a beta-phase half-life of 14.3 +/- 2.8 h. The binding of azapropazone to plasma proteins was high (ranging from 99.52 to 99.67% at a total plasma concentration of 75 micrograms/ml). The bioavailability of azapropazone when administered as capsules was 83 +/- 19%.

Administration, Oral↗
PubMed1978

Digoxin and digitoxin elimination in man by charcoal hemoperfusion.

Since there is no widely used causal means of reducing the severity of massive digitalis intoxication the capability of hemoperfusion with coated activated charcoal to remove toxicologically relevant amounts of digoxin and digitoxin was evaluated in vitro and in man. At a blood flow rate of 100 ml/min the digoxin clearance by hemoperfusion in vitro was 51 +/- 8 ml/min in comparison to 24.3 +/- 11.3 ml/min by hemodialysis. The average hemoperfusion clearance of digitoxin was 31.7 +/- 13.4 ml/min, whereas almost no digitoxin was removed by hemodialysis. These clearance values point to the ability of hemoperfusion of eliminating digitalis glycosides from the blood. They do not clarify the essential question whether it is possible to lower the toxic concentrations in the tissues.

Charcoal↗
PubMed1978

Massive digoxin intoxication in childhood.

In a 10 year old boy 8 hours after taking about 16 mg beta-acetyl-digoxin a maximum serum digoxin level of 31.8 ng/ml was measured radioimmunologically. This is the highest digitalis level in childhood described to date. The serum potassium level rose to 7.4 mmol/l. Complete atrio-ventricular block, and salves of ventricular premature beats were the most serious rhythm disturbances. The absence of life threatening rhythm disturbances is attributed to the early use of diphenylhydantoin in small frequent doses.

Child↗
PubMed1978

Enhanced elimination of warfarin during treatment with cholestyramine.

1 The elimination and anticoagulant activity of a single intravenous dose of warfarin (1.0-1.2 mg/kg) without and with concomitant cholestyramine treatment (about 4 g three times daily) was studied in five healthy male subjects. 2 Cholestyramine treatment decreased the biological half-life of plasma warfarin (from a mean value of 2 days -1.3 days) and increased the total clearance of this drug (from a mean value of 37 ml kg-1 day-1--53 ml kg--1 day--1). 3 The total anticoagulant effect per dose of warfarin, as measured by the area under the effect v time curve, was also reduced by cholestyramine (average reduction of about 25%). 4 Warfarin possibly undergoes enterohepatic recycling in man which can be interrupted by cholestyramine.

Adult↗