Angina. Is Pexid a good choice?

Posted By Joergen Andersen on May 23, 1998 at 07:04:53:







Some days ago I posted a message regarding Pexid in sci,med.cardiology
I have however only had one reply by email, which described it,s
toxidity to the nervous system, which the person had found via a
search engine, that encouraged me to search again and I got following
result

Perhexiline maleate
    Pexid (Sigma Pharmaceuticals)
    100 mg tablets
    Indication: angina
    This drug was introduced to Australia in 1978 (see 'New drugs'
Aust Prescr 1978;2:108), but has not been generally available
    for a few years. The product is being reintroduced for patients
who have contraindications, or have not responded to, other
    treatments for angina. As perhexiline has serious adverse effects,
its use will be restricted to reducing the frequency of attacks
    in patients who have intractable angina, but cannot have coronary
bypass surgery.
    Adverse effects occur in 65% of patients and approximately 8% have
to stop treatment. The severe adverse effects are
    peripheral neuropathy, papilloedema, hypoglycaemia and weight
loss. Changes in liver enzymes occur frequently and some
    patients develop liver damage which can be fatal. All patients
should be examined monthly and have regular monitoring of
    plasma concentrations, glucose and liver function.

http://www.medfac.unimelb.edu.au/ap/volume19/issue2/ap19-2-4.html

As outlined in Articles 2, 11 and 3 ('Half-life'
Aust Prescr 1988;11:57-9), the approach to  steady state is determined
by the half-life and the use, or not, of a loading dose. It is usually
best to wait and assay at steady state unless
there are concerns about toxicity. This does not
apply to drugs such as amiodarone and
perhexiline with very long half-lives and which
can cause severe toxicity - steady state may
take months to be reached and dose
adjustments need to be made along the way.
With all drugs, if a sample is taken before
steady state is reached, allowance needs to be
made for this in interpreting the concentration.
http://www.medfac.unimelb.edu.au/ap/volume20/issue1/ap20-1-6.html


My dosage is 100mg twice daily I have been on the drug since dec 96
I'm coping well at the moment. My last hospitalization was in feb this
year with unstable angina, No bloodtest regime has been arranged,
which surprises me having read the above. I see my GP bimonthly.
Would anybody in this group have any information and with regard to
this drug?
-------------------------------
The Message above is a copy of a post I submitted in sci.med.pharmacy, unfortunenate I have not had any response.
My concern is do I unnessary take a drug which is too toxid?I am aware that the cardiologist at Monash have taken my
condition into consideration, but there does not seem to be much information available
on the net, which means that there perhaps are better alternatives.
I take number of other medications as well
Aspirin half daily Atenolol 50mg Norvasc 10mg
Imdur 120mg at night Zoton 30mg twice daily and
as mentioned Pexid 100mg twice daily
I am going to question my GP in the near future, with regard to
bloodtest. As far as Monash goes they have been very diligent
as far as information about drugs, bar Pexid.
After my Angioplasties did they put me on Ticlid for a month and
imformed my GP to arrange weekly blood tests, I would imagine Ticlid
is a lot safer than Pexid, but I could be wrong and just be a nervous nellie.
I'm also planning to either stop or cut down on Pexid. Would it be a good
idea, or should I wait until some test been. The drug apparently will hang
about for a while, so I might get some other adverse effect.
Hoping Yoy will be able enlighten
many regards Joergen