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Diagnosis and Treatment |

New Drugs: Bretylium Tosylate: A Newly Available Antiarrhythmic Drug for Ventricular Arrhythmias

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▸Requests for reprints should be addressed to J. Thomas Bigger, Jr., M.D.; Department of Medicine, Columbia University, 630 West 168th Street; New York, NY 10032.

New York, New York

© 1979 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1979;91(2):229-238. doi:10.7326/0003-4819-91-2-229
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Bretylium tosylate (Bretylol) has recently been approved for parenteral use against resistant ventricular arrhythmias. The pharmacologic action of bretylium is complex, and its antiarrhythmic action differs significantly from other drugs. Bretylium is an adrenergic neuronal blocking agent taken up selectively at peripheral adrenergic nerve terminals, where it initially releases norepinephrine (sympathomimetic effect) and then produces adrenergic neuronal blockade. It has direct cardiac membrane effect to prolong action potential duration and effective refractory period but, unlike other membrane active antiarrhythmic agents, does not depress conduction velocity or automaticity. Bretylium increases ventricular fibrillation threshold and prevents the decrease in ventricular fibrillation threshold associated with myocardial ischemia. It does not depress myocardial contractility. Clinical studies have shown parenteral bretylium to be effective in suppressing ventricular arrhythmias, particularly recurrent, drug resistant ventricular tachycardia or ventricular fibrillation.





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