Shapiro, Shepard
December 1957
Angiology;Dec1957, Vol. 8 Issue 6, p504
Academic Journal
Anxiety may play a significant role in the production and accentuation of symptoms with organic background in cardiovascular disease. Alleviation of some of the emotional components may be followed by substantial relief of symptoms. The observations made in this study indicate that the regular administration of meprobamate may be effective in this respect and it has been strik- ingly demonstrated, especially in coronary insufficiency and paroxysmal tachycardia. By overcoming anxiety, attacks have been lessened in frequency and intensity and in some instances completely eliminated after meprobamate administration. In the conduct of therapy of cardiovascular disorders in which emotional factors may be very prominent it is recommended that this form of treatment be employed unless contraindication exists. To be sure there may be considerable overlapping in categorizing the cases noted above: patients with essential hypertension may show evidences of coronary disease, or may be subject to crises characterized by paroxysms of tachycardia. In all of these disorders the emo- tional overlay may be of primary importance. Hence, the use of a drug to counteract this is proper therapy. It is important to point out that tranquilizer drug is only an addition to the therapeutic armamentarium. Psychotherapy as employed by the clinician may be essential, and dietary restriction, weight control, vasodilators and circulatory stimulants and anticoagulants when indicated must be used. In a small group of patients it has been found that the addition of meprobamate to Pertrate (penta-erythritol-penta-nitrate) appears to be more effective than Pertrate alone in the control of coronary insufficiency and angina pectoris. The effective- ness of meprobamate in the control of symptoms in mildly disturbed patients with cerebral arteriosclerosis has been satisfactory. Patients of this group, excitable, negativistic and unruly have become obedient, quiet and cooperative, following the regular administration of meprobamate. Extensive studies were made to detect evidences of toxicity. Weekly laboratory examinations including hemograms and evaluation of urinary and liver function yielded no instance of significant alteration. These older patients frequently exhibit subclinical hepatic and renal pathology and are therefore more apt to reveal evidences of toxicity from the drug used. Hence it is especially significant that none was detected in this study. Estimations of prothrombin time by the Link-Shapiro modification of the Quick single-stage technique were made weekly and were all in the normal range. Skin rash was not a problem in this study. It is interesting to note that in two of eight patients with arteriosclerotic endarteritis, claudication was improved strikingly after the use of meprobamate plus dexedrine sulfate at low dosage level. This is being pursued in a continued study. In patients with chronic congestive failure, the addition of meprobamate to the usual supportive therapy has been found helpful in quieting the patient, lessening the anxiety and improving sleep. In vasospastic disorders such as Raynaud's disease meprobamate was without significant effect. The problem of sluggishness or drowsiness after meprobamate arose in some persons taking doses of 400 mg each. Attempts to counteract this by adding 0.5 mg dexedrine sulfate to 400 mg Miltown was not strikingly successful because in some it was followed by sleeplessness at night; hence, the addition of dexedrine was abandoned as a regular procedure. However, with the exception of the elderly patients, it was usually found that meprobamate was equally effective at dosage levels of 200 mg and that the occurrence of drowsiness after this smaller dose was not a problem. For the most part, 200 mg doses are now being used in place of 400 mg in the regular administration of the drug, particularly in patients in whom drowsiness must be avoided.


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