Molsidomine in the Treatment of Patients with Angina Pectoris Acute Hemodynamic Effects and Clinical Efficacy

• Published in: The New England journal of medicine Vol. 302; no. 1; pp. 1 - 6
• Main Authors: Majid, Pirzada A, DeFeyter, Pim J. F, Van der Wall, Ernst E, Wardeh, Rafik, Roos, Jan P
• Format: Journal Article
• Language: English
• Published: Boston Massachusetts Medical Society 03.01.1980
• Subjects: Angina; Angina pectoris; Blood pressure; Body weight; Drug dosages; Electrocardiography; Fitness equipment; Heart diseases; Heart rate; Medical imaging; Nitrates; Nitroglycerin; Pain; Patients; Physical training; Pulmonary arteries; Statistical analysis; Tablets; Veins & arteries; Ventricle
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198001033020101

Molsidomine, a new long-acting vasodilator, was administered intravenously (0.03 mg per kilogram of body weight) to two groups of six patients with stable angina pectoris. In the first group, studied during exercise-induced angina, the drug shortened the duration of pain and reduced electrocardiographically measured ST-segment depression, mean systemic arterial pressure, and mean pulmonary wedge pressure. Cardiac output and heart rate remained unchanged. In the second group, studied during pacing-induced angina, the drug reduced both left ventricular pressures and angiographically estimated ventricular volumes and improved the ejection fraction. In a double-blind crossover comparison with a placebo, molsidomine (2 mg three times daily) reduced the frequency of anginal attacks and the consumption of nitroglycerin tablets in 14 patients. During exercise testing on a treadmill a statistically significant reduction in ST-segment depression lasted for up to six hours. These studies suggest that molsidomine acts like nitroglycerin but its effects last longer. We conclude that molsidomine is effective in preventing the symptoms of angina pectoris. (N Engl J Med 302:1–6, 1980) MOLSIDOMINE (N-ethoxycarbonyl-3-morpholinosydnonimine) belongs to a newly discovered class of sydnonimines and has been recently introduced for the treatment of angina pectoris. Studies in animals have shown that the hemodynamic effects of the drug are similar to those of nitrates but appreciably longer lasting. 1 2 3 Preliminary clinical studies have also indicated that the antianginal effects may last for up to six hours. 4 5 6 7 The following studies were undertaken to examine the hemodynamic effects of molsidomine in a group of patients with exercise-induced angina pectoris. The studies were subsequently extended to evaluate the therapeutic effectiveness and duration of action of the drug in comparison . . .