NIMODIPINE

The actions and interactions of dihydropyridines (DHPs) and ethanol on sinus node (SN) automaticity were studied using rat sinoatrial preparations superfused with Tyrode's solution at 37°C. Intracellular microelectrodes were used to monitor SN rate (SNR). The automaticity of the SN was not affected by nimodipine 10−10 M, but it was depressed by a higher concentration of this calcium antagonist (10−8 M). The racemic compound (±)Bay K 8644 had a dosedependent biphasic chronotropic action: At 10−8 M it decreased the SNR, while at 10−7 M it increased the SNR. The negative component was blocked by atropine. A small concentration of ethanol (1.8×10−2 M) had a positive chronotropic effect on the SN, and this action was blocked by nimodipine 10−10 M. This small concentration of ethanol did not modify the chronotropic effects of either of the DHPs. A higher concentration of ethanol (5.3×10−2 M) did not by itself affect the SNR, but it antagonized the chronotropic actions of the two DHPs.

Outcome of patients with aneurysmal subarachnoid hemorrhage (SAH) has improved over the last decades. Yet, case fatality remains nearly 40% and survivors often have permanent neurological, cognitive and/or behavioural sequelae. Other than nimodipine drug or clinical trials have not consistently improved outcome. We formed a collaboration of SAH investigators to create a resource for prognostic analysis and for studies aimed at optimizing the design and analysis of phase 3 trials in aneurysmal SAH. We identified investigators with data from randomized, clinical trials of patients with aneurysmal SAH or prospectively collected single- or multicentre databases of aneurysmal SAH patients. Data are being collected and proposals to use the data and to design future phase 3 clinical trials are being discussed. This paper reviews some issues discussed at the first meeting of the SAH international trialists (SAHIT) repository meeting. Investigators contributed or have agreed to contribute da...

Recent studies suggest that iron enters cardiomyocytes via the L-type voltage-gated calcium channel (VGCC). The neuronal VGCC may also provide iron entry. As with calcium, extraneous iron is associated with the pathology and progression of neurodegenerative diseases such as Parkinson’s and Alzheimer’s disease. VGCCs, ubiquitously expressed, may be an important route of excessive entry for both iron and calcium, contributing to cell toxicity or death. We evaluated the uptake of 45Ca2+ and 55Fe2+ into NGF-treated rat PC12, and murine N-2α cells. Iron not only competed with calcium for entry into these cells, but iron uptake (similar to calcium uptake) was inhibited by nimodipine, a specific L-type VGCC blocker, and enhanced by FPL 64176, an L-VGCC activator, in a dose-dependent manner. Taken together, these data suggest that voltage-gated calcium channels are an alternate route for iron entry into neuronal cells under conditions that promote cellular iron overload toxicity.

The vascular remodeling associated with hypertension involves oxidative stress and enhanced matrix metalloproteinases (MMPs) expression/activity, especially MMP-2. While previous work showed that lercanidipine, a third-generation dihydropyridine calcium channel blocker (CCB), attenuated the oxidative stress and increased MMP-2 expression/activity in two-kidney, one-clip (2K1C) hypertension, no previous study has examined whether first- or second-generation dihydropyridines produce similar effects. We compared the effects of nifedipine, nimodipine, and amlodipine on 2K1C hypertension-induced changes in systolic blood pressure (SBP), vascular remodeling, oxidative stress, and MMPs levels/activity. Sham-operated and 2K1C rats were treated with water, nifedipine 10 mg/kg/day, nimodipine 15 mg/kg/day, or amlodipine 10 mg/kg/day by gavage, starting 3 weeks after hypertension was induced. SBP was monitored weekly. After 6 weeks of treatment, quantitative morphometry of structural changes in the aortic wall was studied in hematoxylin/eosin-stained sections. Aortic and systemic reactive oxygen species levels were measured by using dihydroethidine and thiobarbituric acid-reactive substances (TBARs), respectively. Aortic MMP-2 levels and activity were determined by gelatin zymography, in situ zymography, and immunofluorescence. Nifedipine, nimodipine, or amlodipine attenuated the increases in SBP in hypertensive rats by approximately 17% (P P P MMP-2 levels and activity associated with 2K1C hypertension. These findings suggest lack of superiority of one particular dihydropyridine, at least with respect to antioxidant effects, MMPs downregulation, and inhibition of vascular remodeling in hypertension.

[Ca2+]i increase is necessary in physiological platelet activity, particularly aggregation and release. The increase of [Ca2+]i observed during platelet activation depends in part on Ca2+ influx from the extracellular medium. The participation of voltage-operated Ca2+ channels as a pathway for Ca2+ entry is controversial. In the present study we have attempted to reinvestigate this problem by measuring aggregation and [Ca2+]i changes in platelets activated by ADP or thrombin and incubated with organic or inorganic blockers of calcium channels. The main findings of the present paper can be summarized as follows: (i) Ni2+, Co2+ and Mn2+, well known inorganic blockers of Ca2+ channels, inhibited platelet aggregation induced by ADP or thrombin in a dose-dependent manner, Ni2+ being the most effective agent. (ii) Thrombin induced a rise in free [Ca2+]i in platelets incubated both in 1 mmol/l Ca2+-containing medium and in nominally Ca2+-free medium; the rise of free [Ca2+]i was in the first case up to 370 ± 31nmol/l and in the second case up to 242 ± 26nmol/l, indicating that this observed difference was due to Ca2+ entry from the extracellular medium. Co2+ and Ni2+ abolished that difference by inhibiting Ca2+ influx. (iii) Nisoldipine, nitrendipine and nimodipine (10–50 nmol/l) inhibited in a dose-dependent manner platelet aggregation induced by either ADP or thrombin in platelets incubated in normal-Ca2+ normal-K+ medium, also, aggregation was inhibited to a similar extent in platelets incubated in normal-Ca2+ high-K+ medium. (iv) Nisoldipine — the most effective dihydropyridine to inhibit platelet aggregation — also inhibited Ca2+ influx in platelets incubated in normal-Ca2+ medium, either in normal-K+ or high-K+ media. Our data support the existence of voltage-operated, dihydropyridine-sensitive calcium channels (L-type) and a physiological role for them in platelet function.

Nimodipine has been shown to be beneficial for recovery from acute vocal fold paralysis (AVFP) in an animal model. prospective, open-label trial of patients with AVFP was performed using nimodipine. Consecutive patients were evaluated and offered nimodipine therapy. Fifty-three patients were considered for treatment with nimodipine. Thirteen did not qualify for inclusion, 5 were lost to follow-up, and 7 had side effects requiring cessation of treatment. Thus 28 patients (30 paralyzed vocal folds) were analyzed. Eighteen of the paralyzed vocal folds experienced recovery of purposeful motion (60%). Historical controls and laryngeal electromyography meta-analysis suggest no more than a 20% recovery rate from AVFP. This open label study using nimodipine for treatment of AVFP demonstrates tripling of the recovery rate of vocal fold motion compared with historical controls. Further study in a randomized, controlled manner is warranted.

The authors describe a rare case of central auditory dysfunction induced by cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). A 55-year-old woman who was admitted after aneurysmal SAH developed cerebral vasospasm on Day 3 affecting mainly the right middle cerebral artery (MCA) and partly the left MCA. The vasospasm became refractory to conventional therapy and was ultimately improved by intraarterial infusion of nimodipine in the right MCA and angioplasty. Severe auditory dysfunction was apparent from Day 10 as the patient was not reactive to speech or environmental sounds. Brain MRI on Day 17 demonstrated infarcted areas mainly in the right hippocampus, medial occipital lobe, and thalamus. The patient underwent further examination using audiometry, speech testing, auditory evoked potentials, functional MRI, and cerebral PET. The initial diagnosis was extended nonverbal agnosia and total pure word deafness. The central auditory dysfunction improved over 6 months, with persisting hyperacusis, tinnitus, and amusia. Central auditory dysfunction is a rare complication after SAH. While cortical deafness may be associated with bilateral lesions of the temporal cortex, partly reversible central auditory dysfunction was observed in this patient after prominently unilateral right temporal lesions. The role of the interthalamic connections can be discussed, as well as the possibility that a less severe vasospasm on the left MCA could have transiently impaired the left thalamocortical auditory pathways.

The combination of starvation and surgical trauma induces disturbances to the intestinal mucosal structure and function, as well as changes in mucosal barrier function in the rat small bowel. The aim of the present study was to evaluate the effects of nimodipine administration, on intestinal mucosal structural changes and enterocyte apoptosis, following laparotomy and subsequent postsurgical starvation (PSS) in the rat. Thirty Wistar rats were divided into two experimental groups: A: Control group (n=15), where the animal models underwent laparotomy and consequent 48-hours PSS and B: Nimodipine group (n=15), where the rats underwent laparotomy, followed by intraperitoneal nimodipine administration and consequent 48-hour (h) PSS. Small bowel mucosal structural changes and enterocyte epithelial apoptosis were determined 48 h following laparotomy. Nimodipine rats (group B) demonstrated a significant decrease in small bowel villous height in jejunum (p=0.016) and ileum (p=0.002). Simila...

The dynamics at the brain level (quantitative EEG), plasma kinetics and effects on blood pressure and heart rate of the Ca antagonists, darodipine (slow-release, 50- 200 mg) and nimodipine (30 mg), were compared in a double-blind cross-over study on healthy volunteers during a 9-hour period following single drug/placebo administration. Increased EEG total power was observed after 100 and 200 mg daropidine; a concomitant decrease of 14.5-32.0 Hz relative power was observed at 100 mg. The 50-mg dose proved ineffective. These effects were correlated with the darodipine plasma concentration only at the 100-mg dose, with indications of an active concentration interval at approximately 5-10 ng/ml; a reduction in diastolic blood pressure and increased heart rate proved to be linearly correlated with the drug plasma concentration throughout the entire concentration range. Comparable EEG effects were observed after nimodipine, but they did not correlate with the plasma concentration. Implications of the predictability of the brain effect from the drug plasma concentration and differential thresholds for the brain action and effects on (peripheral) circulation are suggested.

Calcium antagonists have a variable specificity for cardiac and peripheral activity. Based on such activity, these compounds, new and old, can be classified into 4 categories. Type 1 agents, typified by verapamil, its congeners (tiapamil and gallopamil) and diltiazem, prolong atrioventricular nodal conduction and refractoriness with little effect on ventricular or atrial refractoriness. These actions, to a large extent, account for the antiarrhythmic properties of this type of calcium antagonists. Type 2 agents include nifedipine and other dihydropyridines. In vivo, these agents are devoid of electrophysiologic effects in usual doses and concentrations. They are potent peripheral vasodilators with some selectivity of action for different vascular beds; their overall hemodynamic effects are dominated by this peripheral vasodilatation and reflex augmentation of sympathetic reflexes. Type 3 agents are flunarizine and cinnarizine (piperazine derivatives); in vitro and vivo, they are potent dilators of peripheral vessels, with no corresponding calcium-blocking actions in the heart. Type 4 agents (perhexiline, lidoflazine and bepridil) have a broader pharmacologic profile; they block calcium fluxes in the heart, in the peripheral vessels or in both. They may inhibit the fast channel in the heart and have other electrophysiologic actions. A clear understanding of the varied pharmacologic properties of the different classes of calcium antagonists is likely to provide a rational basis for the use of the newer agents in clinical therapeutics.(ABSTRACT TRUNCATED AT 250 WORDS)

The membrane density of L-type voltage-sensitive Ca(2+) channels (L-VSCCs) of rat hippocampal neurons increases over age [days in vitro (DIV)] in long-term primary cultures, apparently contributing both to spontaneous cell death and to enhanced excitotoxic vulnerability. Similar increases in L-VSCCs occur during brain aging in vivo in rat and rabbit hippocampal neurons. However, unraveling both the molecular basis and the functional implications of these age changes in VSCC density will require determining whether the other types of high-threshold VSCCs (e.g., N, P/Q, and R) also exhibit altered density and/or changes in regulation, for example, by the important G-protein-coupled, membrane-delimited inhibitory pathway. These possibilities were tested here in long-term hippocampal cultures. Pharmacologically defined whole-cell currents were corrected for cell size differences over age by normalization with whole-cell capacitance. The Ca(2+) channel current density (picoamperes per pi...