DETRIMENTAL HAEMODYNAMIC EFFECTS OF CYCLIZINE IN HEART FAILURE

doi:10.1016/S0140-6736(88)91354-2

The Lancet

Volume 331, Issue 8585, 12 March 1988, Pages 560-561

https://doi.org/10.1016/S0140-6736(88)91354-2 Get rights and content

Abstract

The haemodynamic effects of intravenous cyclizine, an antiemetic that is widely given with opioids in left ventricular failure and myocardial infarction, were studied in 11 patients with severe heart failure. Cyclizine significantly increased systemic and pulmonary arterial pressures, and right and left ventricular filling pressures, and negated the venodilatory effects of diamorphine. The use of cyclizine in patients with heart failure should, therefore, be avoided.

References (5)

Rm Nicholl et al.
Alterations m response to somatic pain associated with anaesthesia. XI two non-phenothiazine anti-emetics: cyclizine and trimethobenzamide
Br J Anaesth
(1962)
F. Kerr et al.
Analgesia m myocardial infarction
Br Heart J
(1974)

There are more references available in the full text version of this article.

Cited by (19)

The on- and off-target effects of morphine in acute coronary syndrome: A narrative review
2016, American Heart Journal
Citation Excerpt :
Although the use of pro-kinetic agents such as metoclopramide, also suggested by the IMPRESSION investigators,38 appears logical, we would caution against widespread usage due to the association of this agent with adverse cardiac arrhythmias.45,46 Furthermore, cyclizine, another pro-kinetic, is associated with increased systemic and pulmonary arterial pressures, right and left ventricular filling pressures and thus may increase myocardial demand.47 One alternative may be the administration of oral naloxone to counteract the effect of morphine on mu opioid receptors in the gut.
With potent analgesic properties, perceived hemodynamic benefits and limited alternatives, morphine is the analgesic mainstay for patients with nitrate resistant chest pain due to acute Myocardial Infarction (MI). However, observational data suggest that morphine administration during MI may have negative consequences. While vomiting, hypotension and respiratory depression are established side effects, recent reports have demonstrated attenuated and delayed oral anti-platelet agent absorption, as well as suboptimal reperfusion after MI, all of which may translate into adverse cardiovascular outcomes. These data have resulted in reduced support for morphine in recent European and U.S. clinical practice guidelines for MI; despite the absence of any prospective randomized outcomes trials addressing this question. As such, randomized trials are now necessary to confirm whether or not morphine, which is administered in up to 30% of MI cases, causes adverse clinical outcomes in these patients. However, given that placebo-controlled randomized trial designs evaluating morphine in MI are limited by an ethical requirement for appropriate analgesia, alternative investigational approaches may be necessary. In this article we review the updated evidence for morphine in MI and outline novel strategies that may facilitate future investigation of this clinical dilemma.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012
2012, Revista Espanola de Cardiologia
Management of nausea and vomiting in patients with advanced cancer
2011, Supportive Oncology: (Expert Consult - Online and Print)
Management of nausea and vomiting in patients with advanced cancer
2011, Supportive Oncology
Acute heart failure
2013, Medicina Fluminensis
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012
2013, Revista Romana de Cardiologie

View all citing articles on Scopus

View full text

DETRIMENTAL HAEMODYNAMIC EFFECTS OF CYCLIZINE IN HEART FAILURE

Abstract

Br J Anaesth

Analgesia m myocardial infarction

Br Heart J