Clinical use

Almitrine is active as both an intravenous and an oral preparation. In oral form it has potential in the longer-term management of chronic respiratory failure in patients with chronic obstructive airways disease, either alone or with long-term domiciliary oxygen therapy. Several studies have reported benefit when almitrine is given in daily doses of 100 to 200 mg. There have been reports of the occurrence of peripheral sensory neuropathy between the third and seventh month of treatment in such patients, although whether this is a direct result of the drug or represents the unmasking of the neuropathy reported in association with chronic obstructive airways disease itself is unclear.

In the setting of adult intensive care medicine, almitrine has potential in the management of acute respiratory failure secondary to chronic obstructive airways disease, and there has been interest in a possible role in the management of acute respiratory distress syndrome. The effect of almitrine depends on the degree of hypoxemia present. Almitrine treatment results in a significant improvement in PaO2 over that achieved by oxygen alone until normoxia is attained. There have been small-scale trials of almitrine in acute respiratory failure and, as with doxapram, it appears to have been successful in preventing the need for mechanical respiratory support in a number of cases. However, the results of clinical trials have been inconsistent, perhaps because of variable drug absorption from the gut in such acutely ill patients resulting in suboptimal blood levels. The lack of large-scale trials and the limited availability of the drug itself mean that almitrine cannot be recommended for routine use in acute respiratory failure at this stage.

The observed effect of almitrine on ventilation-perfusion ratios in hypoxic patients has stimulated research into its potential use in acute respiratory distress syndrome. In one small-scale study, almitrine was shown to be as effective as 10 cmH2O of positive end-expiratory pressure in increasing PaO2 and reducing venous admixture in 10 patients with acute respiratory distress syndrome who required continuous mechanical ventilation. Once again, larger studies are required before recommending its use in this circumstance.

Almitrene bismesylate is currently licensed for clinical use in a number of countries worldwide, but not in the United Kingdom or the United States.

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