Hemodynamic and coronary effects of intravenous eletriptan, a 5HT(1B/1D)-receptor agonist

Objective: To investigate the systemic, pulmonary, and coronary artery effe cts of eletriptan, a new 5HT(1B/1D)-agonist in patients undergoing cardiac catheterization. Methods: Ten patients (two men and eight women) without significant obstruc tive coronary artery disease were administered 3.33 mu g/kg/min intravenous eletriptan after they were given a placebo infusion of 0.9% saline solutio n. Serial measurements of right heart and systemic pressures were taken at 5-minute intervals during placebo infusion, eletriptan infusion, and a 30-m inute postinfusion period. Cardiac output by the thermodilution technique a nd coronary angiography were performed every 15 minutes. Quantitative coron ary angiography was carried out to measure coronary artery dimensions. Results: A small but statistically significant increase in occluded wedge p ressure (7.4 versus 8.8 mm Hg; 95% confidence interval [CI], 0.74, 2.51; P < .01), right atrial pressure (5.3 versus 6.1 mm Hg; 95% CI, 0.0, 1.4; P < .05), and mean pulmonary artery pressure (13.2 versus 14.6 mm Hg; 95% CI, 0 .0, 2.7; P = .05) was observed during the eletriptan infusion compared with placebo. A statistically significant increase in systemic vascular resista nce (1256 versus 1519 dyne/sec/cm(-5); 95% CI, 126, 398; P < .01) and pulmo nary vascular resistance (76.4 versus 100.8 dyne/sec/cm(-5); 95% CI, 1.9, 4 6.9; P < .05) was observed in the period after drug infusion. No overall ef fect was observed on the coronary arteries, although a segmental right coro nary artery constriction developed in one patient, possibly as a result of catheter-induced spasm. Conclusions: Eletriptan, a 5HT(1B/1D)-agonist effective in migraine, causes no significant coronary artery constriction in patients without significan t obstructive coronary artery disease. This finding may reflect a relative selectivity for the 5HT(1D)-receptor subtype.