Initial Study of Fenoterol as a Treatment for Heart Failure
Condition: Congestive Heart Failure
MeSH terms: Heart Failure
Study type: Interventional
Phase: Phase 1

Summary: 
      Background:

      - Fenoterol has been used to treat asthma by opening up the airways in the lungs. It also
      increases the heart rate without significantly increasing blood pressure. This means that it
      may help improve heart function by boosting the heart's output. Researchers have developed a
      different form of the drug that may be given to individuals with heart trouble. This new form
      needs more testing. It is especially important to compare the new form with the original form
      of the drug used to treat asthma.

      Objectives:

      - To compare how safe and effective two different forms of Fenoterol are in improving heart
      function.

      Eligibility:

      - Healthy people between 21 and 60 years of age who have no history of heart disease.

      Design:

        -  People will be screened with a medical history, physical exam, blood and urine tests,
           and heart function studies.

        -  Those in the study will have two 36-hour inpatient study visits. At each visit, they
           will have a physical exam and blood and urine tests. They will fast overnight and then
           receive one of the two forms of Fenoterol first thing in the morning. They will not know
           whether they are getting the original or the modified form of the drug. After receiving
           the drug, they will provide frequent blood and urine samples for 24 hours. They will
           have a final exam before being discharged.

        -  Those who take part in the study will have a followup visit 5 to 7 days after the end of
           each study visit. They will provide more blood and urine samples and have a physical
           exam.
    

Detailed description: 
      Fenoterol is a drug that has been used for the treatment of disease like asthma for many
      years. It is available in Canada in an inhaled form where it is called Berotec . Fenoterol
      stimulates receptors in the body called Beta Adrenergic Receptors and is therefore in a
      family of drugs called Beta Agonists. While one particular form of the drug, called a Racemic
      mixture has traditionally been used for asthma, multiple forms of the drug have now been
      produced and it is possible that using one of the newer forms of the drug will have benefits
      for people with heart failure.

      Treatment for heart failure is a complex problem. It is a problem of the heart not pumping
      enough blood to meet the demands of the body and a number of changes that ultimately prove
      harmful in an attempt to compensate for this failure. Scientists have observed several
      effects of Fenoterol that may prove beneficial to people with heart failure. Use of the older
      Fenoterol (Racemic) mixture indicates that the drug causes the heart to pump more blood out
      to the rest of the body by increasing a person s heart rate but having little to no effect on
      their blood pressure. These effects provide a rationale for attempting to develop Fenoterol
      as a possible treatment for congestive heart failure. It is hoped that this new form of the
      drug will prove to have even more benefits.

      However, the new form of the drug (called the R R form ) has not yet been tested in humans.
      Animal studies and scientific understanding of these types of mixtures suggest that it will
      little to no difference between it and the older Racemic form. To test this thinking and
      determine what doses should be used in future studies, we will conduct a Phase I, escalating
      dose study in healthy volunteers using the orally administered forms of the older Racemic
      mixture and newer R R form .

      This study will consist of three groups of 6 people taking doses of the drug by mouth and
      then monitoring their heart rate, blood pressure, blood chemistry, genetic factors, and heart
      function. The first group will get a 2.5 mg dose of the R R form of the drug on one visit and
      then a 5 mg dose of the racemic mixture on the other visit. The second group will get a 5mg
      dose of the R R form on one of their visits and a 10mg dose of the Racemic mixture on the
      other. Finally, the third group will get a 10mg dose of the R R form on one visit and a 20mg
      dose of the Racemic mixture on the other. Also, blood will be collected at regular intervals
      to monitor levels of the drug, its rate of breakdown, changes in blood chemistry, and the
      testing of various genes. All research will be performed at the National Institute on Aging
      (NIA) Clinical Research Unit located on the 5th floor of Harbor Hospital in Baltimore, MD.

      Testing the safety and breakdown of this drug and comparing it to the older Racemic form will
      be an important first step in its development as a new drug for heart failure.

      The specific aims are:

        1. A Phase 1 study in healthy volunteers to establish the body s absorption and breakdown
           of this new form of Fenoterol (R R form) in comparison with the older, established
           Racemic mixture.

        2. To monitor the effects of the drug on heart rate, blood pressure, and cardiac structure
           and function after a person takes the drug.

      Endpoint: This study will provide a safety assessment and will determine the pharmacokinetics
      and bioavailability of (R,R )- and racemic Fenoterol in healthy subjects. In addition,
      information will be gained about the pharmacodynamics of Fenoterol. This will provide
      information for future studies that will evaluate (R,R )-Fenoterol as a potential treatment
      for congestive heart failure.
    

Intervention name(s): Oral R,R'-Fenoterol; Oral Racemic Fenoterol
Intervention type(s): Drug; Drug
Intervention MeSH terms: Fenoterol
Allocation: Randomized
Intervention model: Crossover Assignment
Primary purpose: Treatment
Keywords: Fenoterol; Pharmacodynamics; Pharmacokinetics; Safety; Beta Adrenergic Agonist