59-41-6 Usage
Description
Bretylium is an anti-adrenergic and cardiac depressant (anti-arrhythmic) agent that possesses sympatholytic action, associated with the blockage of norepinephrine (noradrenaline) from presynaptic nerve endings. It also has a direct effect on ischemic myocytes, making it a promising pharmaceutical candidate for various applications.
Uses
Used in Cardiology:
Bretylium is used as an urgent treatment for ventricular tachycardia and ventricular fibrillation, primarily in the severe phase of a myocardial infarction, during which the use of other medications or procedures has proven unsuccessful. It requires great caution and should be used only in urgent situations.
Mechanism of action
Bretylium is poorly absorbed when taken orally, and it is used only in the form of intravenous
or intramuscular injections. However, like many other quaternary ammonium salts,
it initiates a response of neuronal catechoamines, which can cause tachycardia, elevate
blood pressure, and so on.
Clinical Use
Bretylium (Bretylol) was introduced for the treatment
of essential hypertension but subsequently was shown
to suppress the ventricular fibrillation often associated
with acute myocardial infarction.
Bretylium is not to be considered a first-line antiarrhythmic
agent. However, because of its ability to prolong
the refractory period of Purkinje fibers and to elevate
the electrical threshold to ventricular fibrillation,
bretylium has been found useful in the treatment of lifethreatening
ventricular arrhythmias, especially when
conventional therapeutic agents, such as lidocaine or
procainamide, prove to be ineffective. In addition,
bretylium is known to facilitate the reversal of ventricular
fibrillation by precordial electrical shock. Its use
should be limited to no longer than 5 days.
Side effects
The most important side effect associated with the use
of bretylium is hypotension, a result of peripheral vasodilation
caused by adrenergic neuronal blockade (a
guanethidinelike action). Nausea, vomiting, and diarrhea
have been reported with IV administration and
can be minimized by slow infusion. Longer-term problems
include swelling and tenderness of the parotid
gland, particularly at mealtime.
Synthesis
Bretylium, N-(o-bromobenzyl)-N-ethyl-N,N-dimethylammonium tosylate
(18.1.22), is synthesized by reacting o-bromobenzyltosylate with ethyldimethylamine.
Precautions
The associated initial release of catecholamines may result
in an excessive pressor response and stimulation of
cardiac force and pacemaker activity. The resulting increase
in myocardial oxygen consumption in a patient
with ischemic heart disease may lead to ischemic pain
(angina pectoris). Patients in a state of circulatory shock
probably should not be administered bretylium because
of its delayed sympatholytic action.
Check Digit Verification of cas no
The CAS Registry Mumber 59-41-6 includes 5 digits separated into 3 groups by hyphens. The first part of the number,starting from the left, has 2 digits, 5 and 9 respectively; the second part has 2 digits, 4 and 1 respectively.
Calculate Digit Verification of CAS Registry Number 59-41:
(4*5)+(3*9)+(2*4)+(1*1)=56
56 % 10 = 6
So 59-41-6 is a valid CAS Registry Number.
InChI:InChI=1/C11H17BrN.BrH/c1-4-13(2,3)9-10-7-5-6-8-11(10)12;/h5-8H,4,9H2,1-3H3;1H/q+1;/p-1
