and reappraisal Edited
of cardiac and
as an antihypertensive
Richard E. Lee, M.D.* New York, N. Y.
ufficient data are now available to indicate that pargyline hydrochloride has antihypertensive properties, which makes it unique in the class of drugs known as monoamine oxidase inhibitors. The manner in which it produces hypotension is unknown, and is probably not related to its chemical action. In contrast to other substances which reduce blood pressure, it has no ganglionic or peripheral-nerve blocking action. There is little, if any, reduction of the blood pressure with the patient supine; but with the patient erect, effective doses produce a prominent orthostatic effect. For this reason, this drug is recommended primarily for the treatment of hypertension of moderate to severe degree. As an effective antihypertensive, it seems to be uniquely of value in the patient with a prominent elevation of blood pressure in whom the better-known drugs either are ineffective or produce a marked depression. Reserpine or one of its analogues, which are known depressants, might even be continued, with the addition of’ pargyline to reinforce their antihypertensive action and to counteract the depression. The average initial dose is 25.0 mg. daily, with a gradual increase each week of 12.5 to 25 mg. daily. The majority of patients when standing will show a significant fall in blood pressure at dosage Ievels of from 37.5 to 100 mg. daily. Our
own experience parallels that of others. Almost all of 36 patients who were treated and followed for several months to one year demonstrated a significant orthostatic reduction in blood pressure. Tolerance to the antihypertensive action of the drug may occur despite repeated increases in dosage to as much as three times the presently recommended dose. Today, the value of a drug is apt to be judged more by its side effects than its effectiveness as a therapeutic agent. Pargyline hydrochloride is no exception; hence, the emphasis in the literature on the side reactions, which are minor compared with those of other commonly used antihypertensive agents. Nervousness and sleeplessness are commonly noted and may necessitate a reduction in dosage. Muscular twitching may also occur. Gastrointestinal and genitourinary symptoms are rare at the usual dose levels. Dependent edema, with a gain in weight, is occasionally noted. In such instances, the use of a thiazide diuretic as additional medication would be desirable. Although transient derangement in liver function is reported in the literature, we have not encountered this to date. The future status of pargyline hydrochloride is still uncertain. As with all new drugs, particularly enzyme inhibitors, caution is required in its use. Appropriate laboratory studies to rule out any adverse
Received for publication Aug. 5, 1963. *Physician in Charge. Hypertension Clinic and Laboratory, fessor of CIinicaI Medicine, Come11 University Medical New York 21, N. Y.
New York Hospital, New York. N. Y.; and Assistant College, New York, N. Y. Address: 525 East 68th
Am. Heart I. December, 1963
effect on liver function and bone marrow should be made from time to time. Generic
REFERENCES 1. Bryant, J. M., et al.: Antihypertensive properties of pargyline hydrochloride, J.A.M.A., 178:132, 1961.
2. Ford, R. V.: Clinical and pharmacologic observations on a monoamine oxidase inhibitor (pargyline hydrochloride) in hypertension, Current Therap. Res. 3:378, 1961. 3. Bucci, L.-J. C., and Saunders, A: Unique monoamine oxidase inhibitor for depression, Am. J. Psychiat. 118:255, 1961.