Bretylium

Source: Wikipedia, the free encyclopedia.
Bretylium
Clinical data
MedlinePlusa682861
Pregnancy
category
  • AU: C
Routes of
administration		IV, IM
ATC code
Legal status
Legal status
Pharmacokinetic data
BioavailabilityNA
Protein bindingNA
MetabolismNone
Elimination half-life7-8 hours
ExcretionRenal
Identifiers
  • N-(2-bromobenzyl)-N,N-dimethylethanaminium
JSmol)
  • Brc1ccccc1C[N+](CC)(C)C
  • InChI=1S/C11H17BrN/c1-4-13(2,3)9-10-7-5-6-8-11(10)12/h5-8H,4,9H2,1-3H3/q+1 checkY
  • Key:AAQOQKQBGPPFNS-UHFFFAOYSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Bretylium (also bretylium tosylate) is an

ventricular ectopy
.

Originally introduced in 1959 for the treatment of hypertension.[2] Its use as an antiarrhythmic for ventricular fibrillation was discovered and patented by Marvin Bacaner in 1969 at the University of Minnesota.[3]

The American Heart Association removed bretylium from their 2000 ECC/ACC guidelines due to its unproven efficacy and ongoing supply problems. Many have cited these supply problems as an issue of raw materials needed in the production of Bretylium. By the release of the AHA 2005 ECC/ACC guidelines there is no mention of Bretylium and it is virtually unavailable throughout most of the world.[4][5]

On June 8, 2011 bretylium

FDA's discontinued drug list since its withdrawal was not the result of a safety or effectiveness concern.[6] In mid 2019, it was reintroduced. [citation needed
]

Uses

The drug was used in emergency medicine, cardiology, and other specialties throughout the 1980s-1990s for the acute management of ventricular tachycardia and ventricular fibrillation refractory to other first line treatments such as defibrillation or lidocaine.[7]

It is contraindicated in patients with AV (atrioventricular) heart block or digoxin toxicity.

Bretylium should be used only in an ICU or emergency department setting and should not be used elsewhere due to its dramatic actions and its predominant side effect of hypotension.[citation needed]

Experimental uses

It is used in physiological and pharmacological research as an inhibitor of sympathetic transmission. Its mechanism of action is the inhibition of neurotransmitter release from sympathetic nerve terminals, both by the inhibition of action potentials in the nerve terminals and by other mechanisms.[8] Its specificity for sympathetic nerves is achieved because it is a substrate for the noradrenaline transporter;[9] hence, it accumulates inside nerve terminals which have this transporter.

References

  1. PMID 1667290
    .
  2. PMID 13904707
    .
  3. ^ US 3441649, Marvin B Bacaner, "Suppression of cardiac ventricular fibrillation and cardiac arrhythmias with bretylium tosylate", assigned to University of Minnesota 
  4. ISBN 978-0-12-406061-6
    . Retrieved 2015-07-01.
  5. ^ Hypothermia~treatment at eMedicine
  6. ^ "Determination that Bretylium Tosylate Injection, 50 Milligrams/Milliliter, Was Not Withdrawn From Sale for Reasons of Safety or Effectiveness". Food and Drug Administration. December 19, 2011. pp. 78669–70. Retrieved February 22, 2018 – via federalregister.gov. 76 FR 78669
  7. ^ "ACS". kumc.edu. Kansas University Medical Center. Archived from the original on September 4, 2006. Retrieved 2008-09-23.
  8. PMID 18071295
    .
  9. PMID 13803289
    .