Hemodynamic consequences of combined beta-adrenergic and slow calcium channel blockade in man

M. Packer, J. Meller, N. Medina, M. Yushak, H. Smith, J. Holt, J. Guererro, G. D. Todd, R. G. McAllister, R. Gorlin

Research output: Contribution to journalArticlepeer-review

114 Scopus citations


The administration of verapamil to patients receiving β-adrenergic blocking drugs is reported to produce adverse circulatory reactions, but a systematic investigation of this potential drug interaction has not been performed in man. We administered 40-, 80- and 120-mg doses of verapamil orally to 15 patients with angina pectoris who were receiving high doses of propranolol or metoprolol. Verapamil produced dose-dependent decreases in cardiac performance: with 120 mg, cardiac index decreased by 0.38 l/min/m2, stroke volume index decreased by 2.8 ml/beat/m2 and heart rate decreased by 6 beats/min, associated with increases in pulmonary capillary wedge (2.2 mm Hg) and mean right atrial pressures (1.7 mm Hg) (all p <0.01); two patients had marked, but asymptomatic, hypotensive reactions. In contrast, repeat administration of 120-mg doses of verapamil 24-30 hours after withdrawal of β blockade produced no significant cardiodepressant effects despite significantly higher plasma levels of verapamil than during propranolol therapy (383.1 vs 205.1 ng/ml, p <0.01). In conclusion, verapamil produces significant negative inotropic and chronotropic effects in patients treated with β-adrenergic antagonists; combination therapy should therefore be used with caution in patients with angina pectoris.

Original languageEnglish (US)
Pages (from-to)660-668
Number of pages9
JournalUnknown Journal
Issue number4
StatePublished - 1982

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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