Multi-centre experience on the use of perhexiline in chronic heart failure and refractory angina: old drug, new hope.
OBJECTIVE
The objective of this study is to report on our 5-year collective experience on the use of perhexiline in the UK, in patients with chronic heart failure (CHF) and/or refractory angina with respect to 'real-life' drug side effects and toxicity, therapeutic drug level monitoring, 5 year mortality outcomes and predictors of response to perhexiline therapy.


RESULTS
Data on clinical history, perhexiline monitoring, follow-up, and mortality were retrospectively collated from centralized perhexiline databases from two tertiary referral centres. A total of 151 patients were on perhexiline therapy at two UK tertiary referral centres. At 3-4 months, 68.8% of patients had drug level within the therapeutic range and 20.8% were above the therapeutic range. A total of 58.9% of patients reported to have felt better on the perhexiline (responders). The presence of refractory angina was an independent predictor of response to perhexiline therapy (odds ratio 2.84, 95% confidence interval 1.28-6.32, P = 0.01). Five-year mortality was non-significantly different between patients with refractory angina, CHF, or both (20.5, 31.0, and 38.4%, P = 0.20, respectively).


CONCLUSIONS
Perhexiline therapy provides symptomatic relief in the majority of patients with minimal side effects or toxicity. Careful therapeutic level monitoring for dose titration is important to prevent acute and chronic toxicity. Patients with refractory angina were more likely to be responders.
Phan
Thanh Trung
TT
Department of Cardiovascular Medicine, University of Birmingham, Birmingham B15 2TT, UK. ttpquang@hotmail.com
Shivu
Ganesh Nallur
GN
Choudhury
Anirban
A
Abozguia
Khalid
K
Davies
Chris
C
Naidoo
Ulasini
U
Ahmed
Ibrar
I
Yousef
Zaheer
Z
Horowitz
John
J
Frenneaux
Michael
M
D000368:Aged; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000188:drug therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016001:Confidence Intervals; D016903:Drug Monitoring; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010480:Perhexiline / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013997:Time Factors; D017211:Treatment Failure; D014665:Vasodilator Agents / Q000627:therapeutic use*
D002317:Cardiovascular Agents; D014665:Vasodilator Agents; D010480:Perhexiline