Other Significant Cardiovascular Drugs

In contrast, a study in 9 healthy subjects found that although the combination of morphine and cocaine produced significant cardiovascular and subjective effects, for the most part, the cardiovascular effects were similar to those produced by cocaine alone. Neither cocaine nor morphine altered the plasma levels of the other drug. ... 

This method was described previously in Section 9.7 and is effective because it replenishes the supply of dopamine in the brain. Another method for increasing dopamine levels is to slow the rate at which dopamine is removed from the brain. Dopamine is primarily metabolized under the influence of an enzyme (a biological catalyst), called monoamine oxidase B (MAO B). Any drug that inactivates this enzyme will effectively slow the rate at which dopamine is metabolized, thereby slowing the rate at which dopamine levels decrease in the brain. Unfortunately, a closely related enzyme, called MAO A, is used for the metabolism of other compounds, and any drug that inactivates MAO A leads to significant cardiovascular side effects. Therefore, the selective inactivation of MAO B (but not MAO A) is required. The first selective MAO B inactivator, called selegiline, was approved by the FDA in 1989 for the treatment of Parkinson s disease ... 

Cardiovascular conditions - Cholinesterase inhibitors have vagotonic effects on the sinoatrial and atrioventricular nodes, leading to bradycardia and AV block. These actions may be particularly important to patients with supraventricular cardiac conduction disorders or to patients taking other drugs concomitantly that significantly slow heart rate. Consider all patients to be at risk for adverse effects on cardiac conduction. 

In 3040 men with benign prostatic hyperplasia the effects of finasteride 5 mg/day for 4 years were studied in those over and under 65 years (78). In both groups the drug was effective and there were no significant differences in cardiovascular adverse events between placebo and finasteride. There were significant differences between placebo and finasteride in the overall incidence of typical drug-related adverse events, but there were no specific differences associated with age. The principal events were impotence (8.8%), reduced libido (6.8%), reduced volume of ejaculate (3.5%), other disorders of ejaculation (1.5%), rash (0.6%), breast enlargement (0.5%), and breast tenderness (0.2%). 

Other side effects such as gastrointestinal discomfort (nausea and vomiting), dry mouth, sore throat, and muscular incoordination have been reported, but these occur fairly infrequently and vary according to the exact drug used. Cardiovascular and respiratory depression may also occur, but these problems are dose-related and are usually not significant, except in cases of overdose. 

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