Published: 2018-01-18

Protective effect of carvedilol against anthracycline-induced cardiomyopathy on patients with breast cancer and lymphoma

Bijan Zamani, Salehi R., Esfahani A.


Background:Anthracycline antibiotics are potent antineoplastic agents. Unfortunately, despite its broad effectiveness, anthracycline therapy is associated with irreversible dilated cardiomyopathy. Toxic effect may occur at any stage of anthracycline treatment. When it takes place, medical therapy is mostly insufficient. Therefore, prevention of cardiomyopathy has great clinical importance. This study aimed at evaluating the protective effect of carvedilol against anthracycline-induced cardiomyopathy on patients with breast cancer and lymphoma.

Methods: In a randomized clinical trial, 66 patients with breast cancer or lymphoma selected for chemotherapy in Tabriz city hospital. These patients randomized in three groups; the first group (control) received placebo; the second group (A) received carvedilol 6.25mg/d and the third group (B) received carvedilol 12.5mg/d for 4months. Conventional echocardiography and tissue Doppler study were employed for evaluating the patients on the baseline and at the end of survey.

Results:At the end of 4 months of follow-up, 1 (4.5%) patient in group B, 2 (9.1%) patients in group A and 4 (18.2%) patients of the control group had died. Clinical systolic dysfunction was encountered in 5 (27.8%), 5 (25%) and 1 (4.8%) patients in the control, A and B groups, respectively. A distinctive clinical diastolic dysfunction was encountered in 5 (27.8%), 3 (15%) and 3 (14.3%) patients in the control, A and B groups, respectively. Carvedilol with a dose of 6.25mg/d prohibited the diastolic dysfunction at the end of study without a significant effect on the prevention of diastolic dysfunction. Carvedilol with a dose of 12.5mg/d effectively prevented both the systolic and diastolic dysfunctions at the end of study.

Conclusions:The current study showed that prophylactic administration of carvedilol with a dose of 12.5 mg/d might significantly prevent the systolic and diastolic dysfunction of the left ventricle in patients receiving chemotherapy with anthracycline.


Anthracycline, Carvedilol, Cardiomyopathy

Full Text:



Abelmann WH. Classification and natural history of primary myocardial disease. Prog Cardiovasc Dis. 1994;27(2):73-94.

Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and the classification of the cardiomyopathies. Circulation. 2006;113:1807-16.

Fatkin D. Guidelines for the diagnosis and management of familial dilated cardiomyopathy. Heart Lung Circ. 2007;16(1):19-21.

Matsui H, Morishima I, Numaguchi Y. Protective effects of carvedilol against doxorubicin-induced cardiomyopathy in rats. Life Sci. 1999; 65:1265-74.

Santos DL, Moreno AJ, Leino RL. Carvedilol protects against doxorubicin-induced mitochondrial cardiomyopathy. Toxicol Appl Pharmacol. 2002;185:218-27.

Spallarossa P, Garibaldi S, Altieri P. Carvedilol prevents doxorubicin-induced free radical release and apoptosis in cardiomyocytes in vitro. J Mol Cell Cardiol. 2004;37:837-46.

Cruz N, Arocho L, Rosario L, Crespo MJ. Chronic administration of carvedilol improves cardiac function in 6-month-old Syrian cardiomyopathic hamsters. Pharmacology. 2007; 80(2-3):144-50.

Kalay N, Basar E, Ozdogru I, Er O, Cetinkaya Y, Dogan A, et al. Protective effects of carvedilol against anthracycline-induced cardiomyopathy. J Am Coll Cardiol. 206;48(11):2258-62.

Mukai Y, Yoshida T, Nakaike R, Nukai N, Iwato K, Kyo T. Five cases of anthracycline-induced cardiomyopathy effectively treated with carvedilol. Intern Med. 2004;43(11):1087-88.

Dandona P, Karne R, Ghanim H, Hamouda W, Aljada A, Magsino CH Jr. Carvedilol inhibits reactive oxygen species generation by leukocytes and oxidative damage to amino acids. Circulation. 2000;101:122-24.