Cardiovascular & Hematological Agents in Medicinal Chemistry - Online First
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Cardiovascular and Cerebrovascular Events Linked to Abuse and Misuse of Sympathomimetic Nasal Decongestants: A Narrative Review of Clinical Evidence
Authors: Naina Mohamed Pakkir Maideen and Sulthan Al RashidAvailable online: 21 January 2026More LessBackgroundSympathomimetic nasal decongestants such as pseudoephedrine, phenylephrine, oxymetazoline, and xylometazoline are commonly used to relieve nasal blockage caused by allergic rhinitis, infections, or sinus inflammation. They work by activating α-adrenergic receptors, which promote vasoconstriction. However, overuse or inappropriate use of these medications has been linked to serious cardiovascular and cerebrovascular side effects.
ObjectiveThe purpose of this review is to compile the available clinical evidence on the misuse and overuse of sympathomimetic nasal decongestants and their association with detrimental cardiovascular and cerebrovascular outcomes. It examines potential mechanisms, identifies risk factors, highlights diagnostic concerns, and outlines preventive measures.
MethodsA thorough literature search was conducted using databases such as Medline, PubMed, Scopus, Web of Science, and Google Scholar. The selection included case reports, observational studies, pharmacovigilance data, and clinical investigations published in English that evaluated the negative cardiovascular or cerebrovascular effects of sympathomimetic decongestants. Duplicate records were removed.
Results and DiscussionAlthough rare, significant events such as myocardial infarction, stroke, hypertensive crises, and vasospasm have been documented with both oral and intranasal sympathomimetics, particularly when used excessively or in combination with other medications. Strong vasoconstriction, endothelial dysfunction, and elevated sympathetic activity are the primary mechanisms underlying these adverse effects. Nonspecific symptoms and underreporting of OTC drug use can delay diagnosis. Numerous reports suggest potentially serious or fatal outcomes, and most clinical evidence comes from case reports rather than high-level studies.
ConclusionSympathomimetic nasal decongestants are generally safe when used as directed. However, excessive or inappropriate use may lead to potentially fatal cerebrovascular and cardiovascular events. Healthcare professionals should thoroughly review patients’ medication histories and provide clear instructions on proper use. Educating patients on the correct administration of sympathomimetic nasal decongestants and encouraging safer alternatives such as intranasal corticosteroids or saline sprays, when appropriate, is essential. Preventive measures, regulatory oversight, and interprofessional collaboration are crucial to ensuring safe use and reducing adverse outcomes.
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Ceramides and Oxidized Lipids: Convergent Mediators of Cardiometabolic Pathogenesis
Available online: 10 November 2025More Less
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Novel Compounds in Targeting the α1-adrenoceptor for Antihypertensive Therapy
Authors: Sunil Sahu, Pankaj Minj, Dhansay Dewangan, Swarnlata Saraf and Rakesh TirkeyAvailable online: 03 October 2025More LessHypertension, a prevalent cardiovascular condition, increases the risk of strokes and myocardial infarctions by inducing elevated blood pressure. Its prevalence has risen, particularly in low- and middle-income nations. The incidence of hypertension in adults is higher in low- and middle-income countries compared to high-income nations. One significant class of antihypertensive drugs is α1-adrenoceptor antagonists, which inhibit α1-adrenergic receptors and promote vasodilation. Terazosin, doxazosin, tamsulosin, and alfuzosin are examples of α1-adrenoceptor antagonists that have antihypertensive properties; however, they are linked to considerable side effects, including headaches, dizziness, reproductive problems, and postural hypotension. In the last several years, a number of novel α1-adrenergic antagonists have been synthesised by modifications of various pharmacophores such as Isochroman-4-one, Quinazolines, Piperazine, and Quinazoline-triazole, etc. The present review highlights recently synthesized α1-adrenoceptor antagonists for the management of hypertension, and emphasizes their structure-activity relationship and subtype selectivity.
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The Antioxidant and Anti-lipidemic Potential of Angiotensin-converting Enzyme Inhibitor (Ramipril) in L-NAME Hypertensive Rats
Authors: Esther Oluwasola Aluko, Ezekiel Etim Ben and Grace Edet BasseyAvailable online: 21 August 2025More LessIntroductionHypertension is associated with oxidative disturbances and often coexists with metabolic disorders like hyperlipidemia. Some antihypertensive drugs, particularly angiotensin-converting enzyme (ACE) inhibitors, offer benefits beyond lowering blood pressure by addressing related conditions. This study aimed to investigate the effects of ACE inhibitors on oxidative stress and dyslipidemia induced by L-NAME hypertension in rats.
MethodsFifteen male Wistar rats (150–170 g) were divided into three groups. Group 1 received 10 mL/kg distilled water (control), while Groups 2 and 3 were orally administered 60 mg/kg of L-NAME (L-NAME60) for eight weeks to induce hypertension. After this period, Group 2 continued to receive L-NAME60 plus distilled water (HYP), and Group 3 received L-NAME60 plus ramipril (10 mg/kg) (RMHYP) for an additional five weeks. Blood pressure was measured using the tail-cuff method. Serum oxidative stress markers and lipid profiles were analyzed by spectrophotometry.
ResultsThe blood pressure significantly decreased in RMHYP compared to HYP. Malondialdehyde concentration significantly decreased, and antioxidant enzyme levels significantly increased in RMHYP compared to HYP. Serum lipid profiles showed a significant decrease in total cholesterol and triglycerides, as well as atherogenic indices, but a significant increase in high-density lipoprotein cholesterol levels in RMHYP compared to HYP.
DiscussionThis research shows that ramipril not only lowers blood pressure but also significantly reduces oxidative stress and dyslipidemia in L-NAME hypertensive rats, indicating its potential as an effective treatment for metabolic syndrome.
ConclusionThe findings of this study demonstrate that angiotensin-converting enzyme inhibitors (ramipril) have the ability to act as both an antioxidant and an anti-dyslipidemic agent in hypertensive conditions.
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