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European Journal of Heart Failure Advance Access originally published online on August 5, 2009
European Journal of Heart Failure 2009 11(9):881-886; doi:10.1093/eurjhf/hfp106
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Multi-centre experience on the use of perhexiline in chronic heart failure and refractory angina: old drug, new hope

Thanh Trung Phan1,*,{dagger}, Ganesh Nallur Shivu1,{dagger}, Anirban Choudhury2, Khalid Abozguia1, Chris Davies1, Ulasini Naidoo1, Ibrar Ahmed1, Zaheer Yousef2, John Horowitz3 and Michael Frenneaux1

1 Department of Cardiovascular Medicine, University of Birmingham, Birmingham B15 2TT, UK
2 University Hospital of Wales, Cardiff, UK
3 The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia 5011, Australia

* Corresponding author. Tel: +44 121 414 5916, Fax: +44 121414 3713, Email: ttpquang{at}hotmail.com


  Abstract

Aims: 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.

Methods and 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).

Conclusion: 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.

Key Words: Chronic heart failure • Refractory angina • Perhexiline • Mortality and drug monitoring

Received April 20, 2009; Revised June 20, 2009; Accepted June 24, 2009

{dagger} Joint first authors.


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