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Paradoxical pharmacology makes waves

The medical community and the pharmaceutical industry may be facing major changes in the way drugs are prescribed. Recent research has shown that some drugs that were previously thought to be highly detrimental in the treatment of a disease now turn out to be highly effective. A good case in point is congestive heart failure (CHF) and beta-blockers. Patients with CHF have reduced pumping power so need more adrenaline or adrenaline-mimicking drugs to get the heart to work harder. Beta-blockers block adrenaline receptors so conventional pharmacology dictated that beta-blockers should never be used in CHF. About 30 years ago a Swedish cardiologist discovered that giving CHF patients low doses of beta- blockers over the long-term actually strengthened their heart and decreased mortality by 65%. Thus paradoxical pharmacology was born. In this approach, drugs that actually make the patient worse in the short-term are given and result in a very significant long-term improvement. The improvement is believed to be due to the body adapting to a drug and producing a beneficial change in the number or status of the receptors for the particular drug. The approach has been used with spectacular success in CHF and preliminary indications are that it may also be useful in asthma therapy – again using small doses of beta- blockers. Other prominent examples of paradoxical pharmacology are in the treatment of hyperactive children where Ritalin (an amphetamine) is given to calm them down and acne where retinoic acid (a skin irritant) has been found quite effective. Richard Bond, a pharmacologist at the University of Texas, believes that paradoxical pharmacology may prove to be an effective approach to the treatment of 5-10% of all diseases.
Martindale, Diane. What doesn't kill you. New Scientist, October 25, 2003, pp. 38-41

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