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. 1988 Aug;60(2):141–148. doi: 10.1136/hrt.60.2.141

Comparison of the haemodynamic effects of epoprostenol (prostacyclin) and tolazoline.

A Bush 1, C M Busst 1, W B Knight 1, E A Shinebourne 1
PMCID: PMC1216537  PMID: 3046646

Abstract

The haemodynamic effects of infusion of epoprostenol (prostacyclin) and bolus injection of tolazoline were compared in a crossover study in 11 children with pulmonary hypertension caused by pulmonary vascular disease. The children were studied during cardiac catheterisation, while they were anaesthetised, paralysed, and ventilated with 100% oxygen. The order of drug administration was not randomised because tolazoline has a half life of hours whereas epoprostenol has a half life of a few minutes. Both drugs caused pulmonary and systemic vasodilatation, and there were no significant differences between the two. The 95% confidence intervals suggest that tolazoline did not have a clinically important haemodynamic advantage over epoprostenol. Previous reports suggest that serious side effects are common when tolazoline is used in repeated doses; epoprostenol has only a few minor side effects that are rapidly reversible when the infusion is stopped. Epoprostenol is more expensive than tolazoline but this study suggests that epoprostenol is a more suitable pulmonary vasodilator if more than a single dose is required.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams J. M., Hyde W. H., Procianoy R. S., Rudolph A. J. Hypochloremic metabolic alkalosis following tolazoline-induced gastric hypersecretion. Pediatrics. 1980 Feb;65(2):298–300. [PubMed] [Google Scholar]
  2. Bush A., Busst C. M., Knight W. B., Shinebourne E. A. Cardiovascular effects of tolazoline and ranitidine. Arch Dis Child. 1987 Mar;62(3):241–246. doi: 10.1136/adc.62.3.241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bush A., Busst C., Booth K., Knight W. B., Shinebourne E. A. Does prostacyclin enhance the selective pulmonary vasodilator effect of oxygen in children with congenital heart disease? Circulation. 1986 Jul;74(1):135–144. doi: 10.1161/01.cir.74.1.135. [DOI] [PubMed] [Google Scholar]
  4. DRESDALE D. T., SCHULTZ M., MICHTOM R. J. Primary pulmonary hypertension. I. Clinical and hemodynamic study. Am J Med. 1951 Dec;11(6):686–705. doi: 10.1016/0002-9343(51)90020-4. [DOI] [PubMed] [Google Scholar]
  5. Davies N. J., Denison D. M. The measurement of metabolic gas exchange and minute volume by mass spectrometry alone. Respir Physiol. 1979 Feb;36(2):261–267. doi: 10.1016/0034-5687(79)90029-x. [DOI] [PubMed] [Google Scholar]
  6. Davies N. J., Shinebourne E. A., Scallan M. J., Sopwith T. A., Denison D. M. Pulmonary vascular resistance in children with congenital heart disease. Thorax. 1984 Dec;39(12):895–900. doi: 10.1136/thx.39.12.895. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Goetzman B. W., Sunshine P., Johnson J. D., Wennberg R. P., Hackel A., Merten D. F., Bartoletti A. L., Silverman N. H. Neonatal hypoxia and pulmonary vasospasm: response to tolazoline. J Pediatr. 1976 Oct;89(4):617–621. doi: 10.1016/s0022-3476(76)80403-9. [DOI] [PubMed] [Google Scholar]
  8. Heath R. E., Jr Vasospasm in the neonate: response to tolazoline infusion. Pediatrics. 1986 Mar;77(3):405–408. [PubMed] [Google Scholar]
  9. Jones D. K., Higenbottam T. W., Wallwork J. Treatment of primary pulmonary hypertension intravenous epoprostenol (prostacyclin). Br Heart J. 1987 Mar;57(3):270–278. doi: 10.1136/hrt.57.3.270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kelman G. R. Digital computer subroutine for the conversion of oxygen tension into saturation. J Appl Physiol. 1966 Jul;21(4):1375–1376. doi: 10.1152/jappl.1966.21.4.1375. [DOI] [PubMed] [Google Scholar]
  11. Kelminson L. L., Cotton E. K., Vogel J. H. The reversibility of pulmonary hypertension in patients with cystic fibrosis. Observations on the effects of tolazoline hydrochloride. Pediatrics. 1967 Jan;39(1):24–35. [PubMed] [Google Scholar]
  12. McIntosh N., Walters R. O. Effect of tolazoline in severe hyaline membrane disease. Arch Dis Child. 1979 Feb;54(2):105–110. doi: 10.1136/adc.54.2.105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. O'Grady J., Warrington S., Moti M. J., Bunting S., Flower R., Fowle A. S., Higgs E. A., Moncada S. Effects of intravenous infusion of prostacyclin (PGI2) in man. Prostaglandins. 1980 Feb;19(2):319–332. doi: 10.1016/0090-6980(80)90030-1. [DOI] [PubMed] [Google Scholar]
  14. Stevens D. C., Schreiner R. L., Bull M. J., Bryson C. Q., Lemons J. A., Gresham E. L., Grosfeld J. L., Weber T. R. An analysis of tolazoline therapy in the critically-ill neonate. J Pediatr Surg. 1980 Dec;15(6):964–970. doi: 10.1016/s0022-3468(80)80311-3. [DOI] [PubMed] [Google Scholar]
  15. Stevenson D. K., Kasting D. S., Darnall R. A., Jr, Ariagno R. L., Johnson J. D., Malachowski N., Beets C. L., Sunshine P. Refractory hypoxemia associated with neonatal pulmonary disease: the use and limitations of tolazoline. J Pediatr. 1979 Oct;95(4):595–599. doi: 10.1016/s0022-3476(79)80777-5. [DOI] [PubMed] [Google Scholar]
  16. Trompeter R. S., Chantler C., Haycock G. B. Tolazoline and acute renal failure in the newborn. Lancet. 1981 May 30;1(8231):1219–1219. doi: 10.1016/s0140-6736(81)92393-x. [DOI] [PubMed] [Google Scholar]
  17. Ward R. M., Daniel C. H., Kendig J. W., Wood M. A. Oliguria and tolazoline pharmacokinetics in the newborn. Pediatrics. 1986 Mar;77(3):307–315. [PubMed] [Google Scholar]
  18. Wilson R. G., George R. J., McCormick W. J., Raine P. A. Duodenal perforation associated with tolazoline. Arch Dis Child. 1985 Sep;60(9):878–879. doi: 10.1136/adc.60.9.878. [DOI] [PMC free article] [PubMed] [Google Scholar]

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