Nisoldipine in cardiovascular disease : comparative studies with Nifedipine

Donaldson, Kirsteen Morag (1992) Nisoldipine in cardiovascular disease : comparative studies with Nifedipine. University of Southampton, Doctoral Thesis.

Abstract

A series of studies was undertaken to establish whether the pharmacological differences between nifedipine and nisoldipine were reflected in therapeutic benefit. The acute haemodynamic effects of incremental intravenous doses were compared in patients with coronary artery disease treated with atenolol. At doses with equivalent effects on heart rate, nisoldipine 2 μg/kg was a more effective vasodilator whilst nifedipine 10μg/kg caused a greater reduction in left ventricular stroke work. The anti-ischaemic effects of adding slow-release nifedipine 20 mg or nisoldipine 10mg, both twice daily, to atenolol monotherapy were compared in a double-blind placebo-controlled study of 24 patients with stable angina pectoris. Both drugs improved peak exercise capacity but this was not maintained 12 hourspost-dosing. Neither drug was associated with significant subjective benefit or reduction in the amount of ischaemia detected by ambulatory monitoring. The effects of nifedipine and nisoldipine on the finger temperature response to a standardised cold challenge were compared in patients with primary Raynaud's phenomenon using a technique developed for this purpose. No difference was detected between treatments, possibly due to wide variability and difficulty in precipitating attacks of vasospasm. In all studies, equipotent doses of nifedipine and nisoldipine had similar unwanted effects. It is concluded that nisoldipine is a more potent systemic vasodilator than nifedipine with significantly less direct negative inotropic action at equivalent doses. It may therefore be safer when administered with a β-adrenoceptor antagonist or to patients with impaired myocardial function. Doses with similar anti-ischaemic effects had similar durations of action and incidences of unwanted effects.

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