Nicotine Patches Appear Safe for CAD Patients

May 1, 2007 • www.internalmedicinenews.com Cardiovascular Medicine 37 Nicotine Patches Appear Safe for CAD Patients

BY BRUCE JANCIN 30%, but many physicians have been re- induced myocardial defect on single-photon ment arm jumped from 10.9 to 25.2 Denver Bureau luctant to recommend it for their patients emission computed tomography (SPECT) ng/mL, Dr. Leja said. After 1 week, patients with coronary artery disease (CAD) be- to receive either 21-mg nicotine patches or were encouraged to quit smoking while N EW O RLEANS — Nicotine patches cause nicotine is known to increase heart placebo in addition to continuing their usu- continuing to use their assigned patches. are safe for use in smokers with known rate and blood pressure, and can induce al amount of cigarette smoking. The pri- Upon SPECT imaging at week 4, the coronary artery disease and stress-induced vasoconstriction as well, Dr. Monika J. Leja mary end point of the study was change in size of the perfusion defects in the nico- myocardial ischemia, according to the re- reported at the annual scientific session of total perfusion defect size upon repeat stress tine patch group remained unchanged sults of the first-ever randomized, place- the American College of Cardiology. SPECT imaging performed at 1 week. from baseline, although their plasma nico- bo-controlled, multicenter clinical trial to Dr. Leja and her coinvestigators at the There was no change in the total or is- tine levels remained as high as at week 1. examine this issue. Methodist DeBakey Heart Center in Hous- chemic perfusion defect size, compared The trial was supported by Glaxo- Nicotine replacement therapy doubles ton randomized 55 heavy smokers with with baseline, in either group even though SmithKline Consumer Healthcare. Dr. Leja the successful smoking quit rate to about CAD and a quantified 10% or greater stress- plasma nicotine levels in the active-treat- has no financial relationship to disclose. ■

IMPORTANT SAFETY INFORMATION The most common side effects in hypertension trials with carvedilol were nasopharyngitis Patients taking Coreg CR™ (carvedilol (COREG CR) and dizziness and fatigue (COREG) phosphate) Extended-release Capsules or and were generally mild. Coreg® (carvedilol) should avoid abrupt cessation of therapy. Following abrupt cessation of therapy with certain β-blocking agents, exacerbation of angina pectoris and, in INDICATIONS AND DOSING some cases, MI and ventricular arrhythmias Hypertension: COREG CR and COREG are have occurred. The dosage should be reduced indicated for the management of essential gradually over a 1- to 2-week period and the hypertension. COREG CR and COREG can be patient should be carefully monitored. used alone or in combination with other COREG CR and COREG are contraindicated in antihypertensive agents, especially thiazide-type patients with bronchial asthma or related diuretics. Starting dose for COREG CR: 20 mg bronchospastic conditions, second- or third- QD. Uptitrate to 40 mg QD after 1 to 2 weeks, as degree AV block, sick sinus syndrome, or severe needed for blood pressure control. The bradycardia (unless a permanent pacemaker is in maximum/target dose is 80 mg QD, if required. place), in patients with cardiogenic shock or Left Ventricular Dysfunction Following decompensated heart failure (HF) requiring the use Myocardial Infarction: COREG CR and COREG of intravenous inotropic therapy (such patients are indicated to reduce cardiovascular mortality should first be weaned from intravenous therapy in clinically stable patients who have survived the before initiating COREG CR or COREG), in acute phase of an MI and have a left ventricular patients with clinically manifest hepatic impairment ejection fraction (LVEF) )40% (with or without and in patients who are hypersensitive to any symptomatic heart failure [HF]). Starting dose for component of this product. COREG CR: 20 mg QD. Uptitrate to 40 mg QD Like other β-blockers, COREG CR and COREG after 3-10 days as tolerated. The maximum/target should be used with caution in patients with dose is 80 mg QD. If clinically indicated, start at peripheral vascular disease, thyrotoxicosis, or who 10 mg QD and/or uptitrate more slowly. Patients are undergoing major surgery. Caution should also should be maintained on lower doses if higher β doses are not tolerated. No dosing alteration be used in diabetic patients as -blockers may β mask some of the manifestations of hypoglycemia, needed when started after IV or oral -blocker MI particularly tachycardia. Worsening heart failure or treatment. fluid retention may occur during uptitration of Heart Failure: COREG CR and COREG are COREG CR or COREG. indicated for the treatment of mild to severe HF The most common side effects reported in the of ischemic or cardiomyopathic origin, usually in addition to diuretics, angiotensin-converting controlled trials in HF (reported in *10% of patients [both the mild-to-moderate and the enzyme (ACE) inhibitor, and digitalis, to increase severe populations studied] and more frequently survival and, also, to reduce the risk of on COREG) were dizziness, fatigue, weight hospitalization. Starting dose for COREG CR: 10 increase, hypotension, and bradycardia. mg QD for 2 weeks. Uptitration to 20, 40, and 80 Worsening HF symptoms were also reported, but mg QD should occur over successive intervals of with equal or greater frequency in placebo-treated at least 2 weeks, based on tolerability. The patients. maximum/target dose is 80 mg QD. Patients should be maintained on lower doses if higher The most common side effects reported with doses are not tolerated. COREG in the CAPRICORN trial were consistent with the profile of the drug in the US HF trials and the COPERNICUS trial, as well as the health status Please see brief summary of Prescribing of patients. The only additional adverse events Information on the following page. reported in >3% of patients and more frequently on COREG in CAPRICORN were dyspnea, lung edema and anemia.

References: 1. Wetzels GE, Nelemans P, Schouten JS, et al. Facts and fiction of poor compliance as a cause of inadequate blood pressure control: a systematic review. J Hypertens. 2004;22:1849-1855. 2. Prescribing Information for COREG CR. GlaxoSmithKline.