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The influence of tocolytic drugs on cardiac function, large arteries, and resistance vessels

Isabelle Fabry, Peter De Paepe UGent, Jan Kips UGent and Lucas Van Bortel (2011) EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY. 67(6). p.573-580
abstract
Purpose Beta-2 adrenoceptor agonistic drugs like ritodrine have been the reference tocolytic drugs, but are associated with cardiovascular side-effects. Atosiban, a newer drug, is a competitive antagonist of oxytocin and has been claimed to have fewer cardiovascular side effects. Until now, there has mainly been a subjective reporting of adverse reactions and few objective cardiovascular data. Evaluation of the acute effects of therapeutic doses of ritodrine and atosiban compared with placebo on cardiac function, large artery properties, blood pressure, and resistance vessels. Methods A double-blind, randomized trial was carried out in 20 non-pregnant female volunteers. Hemodynamic measurements were made under standardized conditions during kinetic steady state. Cardiac output was measured with echocardiography, large artery properties with an echo-tracking device. The effect on the microcirculation was estimated using the total peripheral resistance index (TPRI). Results Atosiban did not differ from placebo. With ritodrine, cardiac function increased by 79% compared with placebo because of a rise in heart rate (91%). TPRI decreased by 48%. Ritodrine increased the distensibility of the common carotid artery by 62% and the compliance by 83%, independent of blood pressure. Compliance of the common femoral artery increased independently of pressure by 33% and the distensibility by 59%. Aortic pulse wave velocity was not influenced by either medication. Conclusions The present study shows potential beneficial vascular effects of ritodrine that are counterbalanced by the cardiac effects. Atosiban has no clinically relevant cardiovascular effects and may be a good alternative for ritodrine in pregnant women at risk of cardiovascular complications.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
Ritodrine, Atosiban, Cardiovascular function, OXYTOCIN ANTAGONIST ATOSIBAN, PRETERM LABOR, NONINVASIVE DETERMINATION, PREECLAMPTIC PREGNANCY, BLOOD-PRESSURE, BETA-AGONISTS, RITODRINE, STIFFNESS, MULTICENTER, NIFEDIPINE
journal title
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY
Eur. J. Clin. Pharmacol.
volume
67
issue
6
pages
573 - 580
Web of Science type
Article
Web of Science id
000291607500004
JCR category
PHARMACOLOGY & PHARMACY
JCR impact factor
2.845 (2011)
JCR rank
91/259 (2011)
JCR quartile
2 (2011)
ISSN
0031-6970
DOI
10.1007/s00228-011-1040-5
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1861088
handle
http://hdl.handle.net/1854/LU-1861088
date created
2011-07-26 13:10:49
date last changed
2016-12-19 15:46:25
@article{1861088,
  abstract     = {Purpose Beta-2 adrenoceptor agonistic drugs like ritodrine have been the reference tocolytic drugs, but are associated with cardiovascular side-effects. Atosiban, a newer drug, is a competitive antagonist of oxytocin and has been claimed to have fewer cardiovascular side effects. Until now, there has mainly been a subjective reporting of adverse reactions and few objective cardiovascular data. Evaluation of the acute effects of therapeutic doses of ritodrine and atosiban compared with placebo on cardiac function, large artery properties, blood pressure, and resistance vessels. 
Methods A double-blind, randomized trial was carried out in 20 non-pregnant female volunteers. Hemodynamic measurements were made under standardized conditions during kinetic steady state. Cardiac output was measured with echocardiography, large artery properties with an echo-tracking device. The effect on the microcirculation was estimated using the total peripheral resistance index (TPRI). 
Results Atosiban did not differ from placebo. With ritodrine, cardiac function increased by 79\% compared with placebo because of a rise in heart rate (91\%). TPRI decreased by 48\%. Ritodrine increased the distensibility of the common carotid artery by 62\% and the compliance by 83\%, independent of blood pressure. Compliance of the common femoral artery increased independently of pressure by 33\% and the distensibility by 59\%. Aortic pulse wave velocity was not influenced by either medication. 
Conclusions The present study shows potential beneficial vascular effects of ritodrine that are counterbalanced by the cardiac effects. Atosiban has no clinically relevant cardiovascular effects and may be a good alternative for ritodrine in pregnant women at risk of cardiovascular complications.},
  author       = {Fabry, Isabelle and De Paepe, Peter and Kips, Jan and Van Bortel, Lucas},
  issn         = {0031-6970},
  journal      = {EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY},
  keyword      = {Ritodrine,Atosiban,Cardiovascular function,OXYTOCIN ANTAGONIST ATOSIBAN,PRETERM LABOR,NONINVASIVE DETERMINATION,PREECLAMPTIC PREGNANCY,BLOOD-PRESSURE,BETA-AGONISTS,RITODRINE,STIFFNESS,MULTICENTER,NIFEDIPINE},
  language     = {eng},
  number       = {6},
  pages        = {573--580},
  title        = {The influence of tocolytic drugs on cardiac function, large arteries, and resistance vessels},
  url          = {http://dx.doi.org/10.1007/s00228-011-1040-5},
  volume       = {67},
  year         = {2011},
}

Chicago
Fabry, Isabelle, Peter De Paepe, Jan Kips, and Lucas Van Bortel. 2011. “The Influence of Tocolytic Drugs on Cardiac Function, Large Arteries, and Resistance Vessels.” European Journal of Clinical Pharmacology 67 (6): 573–580.
APA
Fabry, I., De Paepe, P., Kips, J., & Van Bortel, L. (2011). The influence of tocolytic drugs on cardiac function, large arteries, and resistance vessels. EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, 67(6), 573–580.
Vancouver
1.
Fabry I, De Paepe P, Kips J, Van Bortel L. The influence of tocolytic drugs on cardiac function, large arteries, and resistance vessels. EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY. 2011;67(6):573–80.
MLA
Fabry, Isabelle, Peter De Paepe, Jan Kips, et al. “The Influence of Tocolytic Drugs on Cardiac Function, Large Arteries, and Resistance Vessels.” EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 67.6 (2011): 573–580. Print.