1. J Hum Hypertens. 1989 Dec;3(6):419-25.

Doxazosin, a new alpha-1-antagonist drug, controls hypertension without causing airways obstruction in asthma and COPD. Biernacki W(1), Flenley DC. Author information: (1)Department of Respiratory Medicine, University of Edinburgh, City Hospital, Scotland, UK. The treatment of systemic hypertension in patients with coexisting chronic airflow limitation is difficult. Even a 'cardioselective' beta-blocker potentially can increase airflow limitation. However it is very unlikely that alpha 1 blockers can bronchoconstrict. We have therefore evaluated the efficacy and safety of doxazosin, a new orally active selective alpha 1 blocker, in patients with systemic hypertension with concomitant airflow limitation. We studied 21 patients (11M, 10F) whose diastolic blood pressure was 95-114 mmHg an d FEV1 22-73% of predicted. In the 19 patients who completed the study the dose of doxazosin to achieve satisfactory control of the systemic hypertension lay between 1 and 16 mg (mean 6 +/- 3.6 mg). This doxazosin dosage reduced the diastolic blood pressure on average from 103 to 91 mmHg (P = 0.0001). However this produced no significant changes in peak expiratory flow rate (PEFR) over th e days of the study (P greater than 0.05). The mean variations in PEFR both 'day t o day' (P less than 0.001) and 'within day' (P less than 0.002) were reduced durin g doxazosin therapy, and FEV1 rose on average from 1.6 to 1.7 (P less than 0.05). We conclude that doxazosin is an effective oral antihypertensive drug, which doe s not exacerbate pre-existing airflow limitation. PMID: 2575174 [PubMed - indexed for MEDLINE] 2. Recenti Prog Med. 1991 Dec;82(12):682-5. [Respiratory effects of antihypertensive agents acting on alpha adrenergic receptors]. [Article in Italian] Malerba M(1), Agabiti-Rosei E. Author information: (1)Cattedra di Medicina interna, UOP Scienze mediche, Universit, Brescia. There are several factors involved in the bronchial muscle tone regulation, such as biochemical, nervous and humoral mechanisms. In general, in chronic obstructive bronchopneumopathy there is a reduction in air flow, due to differen t physiopathologic factors which, alone or combined, produce these disorders. In particular, according to suggestive hypotheses, it seems that asthma is due to a partial or complete block of beta-receptors with a prevalence of alpha-receptors

and subsequent bronchial hypertonicity and hyperactivity, while in patients with allergic asthma a deficiency of beta-2-adrenergic system and an hyperresponsiveness of alpha-adrenergic and/or cholinergic system have been suggested. In relation to this part, alpha-1 antagonist drugs demonstrated to have a bronchodilator effect, thanks to their mechanism of action. Examples of this class of drugs are prazosin, indoramin, and an analogous of prazosin, doxazosin, which has a high antagonist and selective action for post-synaptic alpha-1 adrenergic receptors and a longer half-life. Several and recent observations show that these drugs do not interfere with the respiratory functio n principal parameters, both in healthy and in asthmatic or chronic bronchopathy subjects, but produce an appreciable improvement of these parameters. Presynapti c alpha-2-adrenergic receptors agonist drugs would mainly act by inhibiting the central nervous system, with a subsequent lower stimulation of post-synaptic alpha-1-adrenergic receptors. Examples of this class of drugs are clonidine, rilmenidine and guanabenz (but, in this case, the effects on the respiratory function are more controversial).(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1687712 [PubMed - indexed for MEDLINE] 3. Australas J Dermatol. 1998 Aug;39(3):171-2. Hypersensitivity syndrome reaction to oral terbinafine. Gupta AK(1), Porges AJ. Author information: (1)Department of Medicine, Sunnybrook Health Science Center, Toronto, Canada. gupta@execulink.com.ca Terbinafine is used extensively to treat onychomycosis and other dermatomycoses. The case of a patient who developed a hypersensitivity syndrome reaction to oral terbinafine is discussed. A 66-year-old male was placed on terbinafine (250 mg/day) for the treatment of onychomycosis. After 4.5 weeks of therapy, the patient developed a cutaneous eruption, pyrexia, lymph-adenopathy and hepatic dysfunction. No infectious or other cause was found for the symptoms and signs, which resolved within 6 weeks of stopping terbinafine. The patient had been on prednisone, doxazosin mesylate and aspirin for several months prior to starting terbinafine. These medications were continued during the episode and subsequentl y afterwards, with adjustment to the prednisone dosage only. The hypersensitivity syndrome reaction in this case involved multiple systems and was idiosyncratic i n nature with no apparent predisposing factors. With the increasing use of oral terbinafine, it is likely that rare adverse events will occur more frequently. I t is, therefore, important for physicians to be aware of the possible development of a hypersensitivity syndrome reaction in a patient on terbinafine who experiences an adverse event with multisystem involvement. Prompt recognition an d determination of the extent of systemic involvement is important for the proper management of the patient. PMID: 9737044 [PubMed - indexed for MEDLINE]