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Pressor and Diminished Local Vasoconstrictor Effects of Levarterenol-Phentolamine Mixtures

Pressor and Diminished Local Vasoconstrictor Effects of Levarterenol-Phentolamine Mixtures Abstract Levarterenol (l-norepinephrine [Levophed]) bitartrate is one of the most commonly used pressor amines in the treatment of shock. However, a major disadvantage is the development of ischemic necrosis in areas of accidental extravasation. On the basis of clinical use, starting in 1954, it was demonstrated by one of us1 that, in such areas, the local vasoconstrictor effect could be counteracted by phentolamine (Regitine) methanesulfonate, an antiadrenergic drug. When 5-10 mg. of the latter drug, diluted in 20 cc. of water, was infiltrated subcutaneously throughout the area of ischemia, the pallor and coldness disappeared within five to seven minutes. Untreated areas became necrotic. Similar observations have been made by McGinn and his co-workers,2 who added hyaluronidase to the phentolamine solution. Pelner 3 cited a case in which hyaluronidase favored the spread of ischemia. He also reported that another antiadrenergic drug, piperoxan (Benodaine), had an action similar to that References 1. Regitine, supplied by Ciba Pharmaceutical Products, Inc., Summit, N. J. 2. Levophed, supplied by Winthrop Laboratories, New York. 3. Information supplied by W. J. Mader and S. E. Slack, of the Research Department, Ciba Pharmaceutical Products, Inc. 4. Since the completion of this manuscript, 65 additional cases of shock have been treated with varying mixtures of levarterenol and phentolamine. Twenty-seven extravasations have occurred without any evidence of ischemic necrosis. Experiments on 36 rabbits demonstrated that as little as 2.5 mg. of phentolamine prevented necrosis invariably produced by solutions containing 8, 16, or 32 mg. of levarterenol per liter. 5. Zucker, G.: Use of Phentolamine to Prevent Necrosis Due to Levarterenol , J. A. M. A. 163: 1477-1479 ( (April 20) ) 1957.Crossref 6. McGinn, J. T.; Schluger, J., and Di Gregorio, N. J.: Prevention of Levarterenol Sloughs: Preliminary Report , New York J. Med. 56:1950-1951 ( (June 15) ) 1956. 7. Pelner, L.: Treatment of Local Ischemia Due to Levarterenol (Levophed) Leakage with Piperoxan , J. A. M. A. 165:444-447 ( (Oct. 5) ) 1957.Crossref 8. Plummer, A. J., Director of the Macrobiologic Research Division, Ciba Pharmaceutical Products Inc.: Personal communication to the authors. 9. Schmitt, H.: Dissociation par la phentolamine des effects des médiateurs chimiques (adrénaline et noradrénaline) et des actions provoquées par l'excitation des nerfs sympathiques , Arch. internat. pharmacodyn. 109:271-279 ( (Feb. 1) ) 1957. 10. Johnson, H. D.; Green, H. D., and Lanier, J. T.: Comparison of Adrenergic Blocking Action of Ilidar (Ro 2-3248), Regitine (C-7337), and Priscoline in Innervated Saphenous Arterial Bed (Skin Exclusive of Muscles) and Femoral Arterial Bed (Muscle Exclusive of Skin) of an Anesthetized Dog , J. Pharmacol. & Exper. Therap. 108:144-157 ( (June) ) 1953. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Internal Medicine American Medical Association

Pressor and Diminished Local Vasoconstrictor Effects of Levarterenol-Phentolamine Mixtures

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References (7)

Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0888-2479
DOI
10.1001/archinte.1959.00270100093015
Publisher site
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Abstract

Abstract Levarterenol (l-norepinephrine [Levophed]) bitartrate is one of the most commonly used pressor amines in the treatment of shock. However, a major disadvantage is the development of ischemic necrosis in areas of accidental extravasation. On the basis of clinical use, starting in 1954, it was demonstrated by one of us1 that, in such areas, the local vasoconstrictor effect could be counteracted by phentolamine (Regitine) methanesulfonate, an antiadrenergic drug. When 5-10 mg. of the latter drug, diluted in 20 cc. of water, was infiltrated subcutaneously throughout the area of ischemia, the pallor and coldness disappeared within five to seven minutes. Untreated areas became necrotic. Similar observations have been made by McGinn and his co-workers,2 who added hyaluronidase to the phentolamine solution. Pelner 3 cited a case in which hyaluronidase favored the spread of ischemia. He also reported that another antiadrenergic drug, piperoxan (Benodaine), had an action similar to that References 1. Regitine, supplied by Ciba Pharmaceutical Products, Inc., Summit, N. J. 2. Levophed, supplied by Winthrop Laboratories, New York. 3. Information supplied by W. J. Mader and S. E. Slack, of the Research Department, Ciba Pharmaceutical Products, Inc. 4. Since the completion of this manuscript, 65 additional cases of shock have been treated with varying mixtures of levarterenol and phentolamine. Twenty-seven extravasations have occurred without any evidence of ischemic necrosis. Experiments on 36 rabbits demonstrated that as little as 2.5 mg. of phentolamine prevented necrosis invariably produced by solutions containing 8, 16, or 32 mg. of levarterenol per liter. 5. Zucker, G.: Use of Phentolamine to Prevent Necrosis Due to Levarterenol , J. A. M. A. 163: 1477-1479 ( (April 20) ) 1957.Crossref 6. McGinn, J. T.; Schluger, J., and Di Gregorio, N. J.: Prevention of Levarterenol Sloughs: Preliminary Report , New York J. Med. 56:1950-1951 ( (June 15) ) 1956. 7. Pelner, L.: Treatment of Local Ischemia Due to Levarterenol (Levophed) Leakage with Piperoxan , J. A. M. A. 165:444-447 ( (Oct. 5) ) 1957.Crossref 8. Plummer, A. J., Director of the Macrobiologic Research Division, Ciba Pharmaceutical Products Inc.: Personal communication to the authors. 9. Schmitt, H.: Dissociation par la phentolamine des effects des médiateurs chimiques (adrénaline et noradrénaline) et des actions provoquées par l'excitation des nerfs sympathiques , Arch. internat. pharmacodyn. 109:271-279 ( (Feb. 1) ) 1957. 10. Johnson, H. D.; Green, H. D., and Lanier, J. T.: Comparison of Adrenergic Blocking Action of Ilidar (Ro 2-3248), Regitine (C-7337), and Priscoline in Innervated Saphenous Arterial Bed (Skin Exclusive of Muscles) and Femoral Arterial Bed (Muscle Exclusive of Skin) of an Anesthetized Dog , J. Pharmacol. & Exper. Therap. 108:144-157 ( (June) ) 1953.

Journal

A.M.A. Archives of Internal Medicine – American Medical Association

Published: Oct 1, 1959

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