ganglionic blockers


Summary: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery.

Top Publications

  1. Tack C, van Gurp P, Holmes C, Goldstein D. Local sympathetic denervation in painful diabetic neuropathy. Diabetes. 2002;51:3545-53 pubmed
    ..The results provide neurochemical and neuroimaging evidence for regionally selective sympathetic denervation in the painful feet of patients with diabetic neuropathy. ..
  2. Abdelrahman A, Lin Lim S, Pang C. Influence of urocortin and corticotropin releasing factor on venous tone in conscious rats. Eur J Pharmacol. 2005;510:107-11 pubmed
    ..In ganglion-blocked rats, urocortin and the highest dose of CRF decreased mean circulatory filling pressure. In conclusion, both urocortin and CRF are vasodepressor agents with venodilator action. ..
  3. Li M, Dai X, Watts S, Kreulen D, Fink G. Increased superoxide levels in ganglia and sympathoexcitation are involved in sarafotoxin 6c-induced hypertension. Am J Physiol Regul Integr Comp Physiol. 2008;295:R1546-54 pubmed publisher
    ..The results suggest that S6c-induced hypertension is partially mediated by sympathoexcitation to the splanchnic organs driven by increased oxidative stress in prevertebral sympathetic ganglia. ..
  4. Castagliuolo I, Lamont J, Letourneau R, Kelly C, O Keane J, Jaffer A, et al. Neuronal involvement in the intestinal effects of Clostridium difficile toxin A and Vibrio cholerae enterotoxin in rat ileum. Gastroenterology. 1994;107:657-65 pubmed
    ..Neuronal mechanisms are important in the in vivo effects of these two enterotoxins. Capsaicin-sensitive sensory afferent neurons and mast cells are involved in the intestinal mechanism of toxin A, but not cholera toxin. ..
  5. Lefebvre C, Lusher A, Dickersin K, Manheimer E. Literature searches. Lancet. 2002;359:896 pubmed
  6. Chan Y, Orie N, Dyson A, Taylor V, Stidwill R, Clapp L, et al. Inhibition of vascular adenosine triphosphate-sensitive potassium channels by sympathetic tone during sepsis. Crit Care Med. 2012;40:1261-8 pubmed publisher
    ..This may explain, at least in part, the reduced efficacy of adenosine triphosphate-sensitive potassium channel blockers in human septic shock. ..
  7. Grider J. Identification of neurotransmitters regulating intestinal peristaltic reflex in humans. Gastroenterology. 1989;97:1414-9 pubmed
    ..The components of the human peristaltic reflex and transmitters regulating them were identical to those found in rat and guinea pig intestine. ..
  8. Hey J, Del Prado M, Chapman R. Activation of a novel medullary pathway elicits a vagal, cholinergic bronchoconstriction in guinea-pigs. Pulm Pharmacol. 1990;3:53-4 pubmed
    ..Removal of the latter by spinal section potentiated CNS-induced bronchospasm. ..
  9. Werner C, Hoffman W, Thomas C, Miletich D, Albrecht R. Ganglionic blockade improves neurologic outcome from incomplete ischemia in rats: partial reversal by exogenous catecholamines. Anesthesiology. 1990;73:923-9 pubmed
    ..05). Administration of exogenous epinephrine and norepinephrine in the presence of N2O and ganglionic blockade (group 3) worsened neurologic outcome compared to group 2 (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) ..

More Information


  1. Berthoud H, Fox E, Powley T. Localization of vagal preganglionics that stimulate insulin and glucagon secretion. Am J Physiol. 1990;258:R160-8 pubmed
    ..These medial, longitudinal dmnX columns and their associated abdominal vagal branches are likely to play the predominant role in vagal control of the endocrine pancreas. ..
  2. Rossi R, Scharrer E. Vasopressin increases blood glucose in pygmy goats (Capra hircus) by an alpha-adrenergic mechanism. Comp Biochem Physiol A Comp Physiol. 1991;100:863-6 pubmed
    ..The ganglion blocking agent hexamethonium also reversed VP's hyperglycaemic effect. 5. It is concluded that VP's hyperglycaemic effect in pygmy goats is due to an increase in sympathetic outflow and not to a direct action on the liver. ..
  3. Lavery W, Kiel J. Effects of head down tilt on episcleral venous pressure in a rabbit model. Exp Eye Res. 2013;111:88-94 pubmed publisher
    ..Also, as in humans, the model reveals no change in aqueous flow during head down tilt. We conclude the rabbit model is appropriate for studying the mechanisms responsible for the relative immunity of EVP and IOP to posture change. ..
  4. Hong Y, Henry J. Intrathecal administration of non-NMDA receptor agonists increases arterial pressure and heart rate in the rat. Brain Res. 1992;591:62-8 pubmed
    ..Intrathecal administration of kynurenate (125 nmol; n = 6; 500 nmol; n = 7) decreased arterial pressure and/or heart rate.(ABSTRACT TRUNCATED AT 250 WORDS) ..
  5. Xue B, Pamidimukkala J, Lubahn D, Hay M. Estrogen receptor-alpha mediates estrogen protection from angiotensin II-induced hypertension in conscious female mice. Am J Physiol Heart Circ Physiol. 2007;292:H1770-6 pubmed
    ..Together, these data indicate that ERalpha, especially central expression of the ER, mediates the protective effects of estrogen against ANG II-induced hypertension. ..
  6. Sheriff D. Hypotensive effect of push-pull gravitational stress occurs after autonomic blockade. J Appl Physiol (1985). 2003;95:167-71 pubmed
    ..05). Cardiac output fell similarly in both conditions. Thus a push-pull effect attributable to a rise in total vascular conductance occurs when autonomic function is inhibited. ..
  7. Swenson S, Speth R, Porter J. Effect of a perinatal high-salt diet on blood pressure control mechanisms in young Sprague-Dawley rats. Am J Physiol Regul Integr Comp Physiol. 2004;286:R764-70 pubmed
    ..The elevated blood pressure appears to be caused by increased sympathetic nervous activity, resulting, in part, from increased brain AT(1) receptor activation. ..
  8. Ferrari A, Radaelli A, Mori T, Mircoli L, Perlini S, Meregalli P, et al. Nitric oxide-dependent vasodilation and the regulation of arterial blood pressure. J Cardiovasc Pharmacol. 2001;38 Suppl 2:S19-22 pubmed
  9. Pelosi G, Tavares R, Antunes Rodrigues J, Correa F. Cardiovascular responses to noradrenaline microinjection in the ventrolateral periaqueductal gray of unanesthetized rats. J Neurosci Res. 2008;86:712-9 pubmed
    ..The results suggest that activation of noradrenergic synapses within the vlPAG modulates vasopressin release in unanesthetized rats. ..
  10. Wirz S, Wartenberg H, Nadstawek J, Kinsky I. [Superior cervical ganglion: an anatomical variant. Are variations of the cranial carotid artery a risk factor for accidental intravascular injection?]. Anaesthesist. 2008;57:689-92 pubmed publisher
    ..With an incidence of 25%, an aberrant carotid artery could possibly facilitate an accidental intravascular injection during ganglionic local opioid application at the superior cervical ganglion. ..
  11. Sonoyama K, Fujiwara R, Kasai T. Non-effect of hexamethonium, a ganglionic blocker, on the response of ileal apolipoprotein A-IV mRNA following a massive small bowel resection in rats. Biosci Biotechnol Biochem. 2000;64:1282-4 pubmed
    ..The result suggests that upregulation of the apolipoprotein A-IV gene in the residual ileum is not mediated by a neural pathway, including the nicotinic synapse route. ..
  12. Burcelin R, Thorens B. Evidence that extrapancreatic GLUT2-dependent glucose sensors control glucagon secretion. Diabetes. 2001;50:1282-9 pubmed
    ..due to an abnormally increased tone of the autonomic nervous system, fed mutant mice were injected with the ganglionic blockers hexamethonium and chlorisondamine...
  13. Stebbins C. Reflex cardiovascular response to exercise is modulated by circulating vasopressin. Am J Physiol. 1992;263:R1104-9 pubmed
    ..Last, when the pressor and contractile responses to contraction were initially augmented by administration of V1-x + V2-x, subsequent ganglionic blockade abolished the entire cardiovascular response.(ABSTRACT TRUNCATED AT 250 WORDS) ..
  14. Zhao G, Walsh E, Shryock J, Messina E, Wu Y, Zeng D, et al. Antiadrenergic and hemodynamic effects of ranolazine in conscious dogs. J Cardiovasc Pharmacol. 2011;57:639-47 pubmed publisher
    ..Ranolazine, at plasma concentrations <10 μM and in conscious dogs with intact autonomic regulation, had minimal antiadrenergic (α and β) effects. ..
  15. Ji X, Wang A, Trandafir C, Kurahashi K. Influence of experimental subarachnoid hemorrhage on nicotine-induced contraction of the rat basilar artery in relation to nicotinic acetylcholine receptors, calcium, and potassium channels. J Stroke Cerebrovasc Dis. 2013;22:371-7 pubmed publisher
    ..SAH did not affect any of the subfamilies of nAChR, but the Ca(2+) channel was reduced and the adenosine triphosphate-sensitive K(+) channel was enhanced by SAH. ..
  16. Twynstra J, Medeiros P, Lacefield J, Jackson D, Shoemaker J. Y1R control of sciatic nerve blood flow in the Wistar Kyoto rat. Microvasc Res. 2012;84:133-9 pubmed publisher
    ..We conclude that the late dilation following Hex which is reversed by Y1R activation suggests some level of sympathetic control over sciatic nerve blood flow. ..
  17. Wilson T, Zhang R, Levine B, Crandall C. Dynamic autoregulation of cutaneous circulation: differential control in glabrous versus nonglabrous skin. Am J Physiol Heart Circ Physiol. 2005;289:H385-91 pubmed
    ..Conversely, these data suggest that nonglabrous skin has diminished dynamic autoregulatory capabilities. ..
  18. Cinca J, Rodriguez Sinovas A, Anivarro I, Moure C, Tresànchez M, Soler Soler J. Neurally mediated depressor hemodynamic response induced by intracoronary catheter balloon inflation in pigs. Cardiovasc Res. 2000;46:198-206 pubmed
    ..A depressor hemodynamic response subserved by pericoronary nerves worsens the LV dysfunction induced by brief coronary catheter balloon inflation in anesthetized pigs. Cholinergic fibers do not appear to play a major role. ..
  19. Xue B, Badaue Passos D, Guo F, Gomez Sanchez C, Hay M, Johnson A. Sex differences and central protective effect of 17beta-estradiol in the development of aldosterone/NaCl-induced hypertension. Am J Physiol Heart Circ Physiol. 2009;296:H1577-85 pubmed publisher
    ..Taken together, the results indicate that central estrogen plays a protective role in the development of Aldo/NaCl-induced hypertension and that this may result from reduced sympathetic outflow. ..
  20. Bouloux P, Corsello S, Besser M, Grossman A. The acute cardiovascular actions of intravenous thyrotrophin releasing hormone (TRH) in man are mediated by non-catecholaminergic mechanisms. Br J Clin Pharmacol. 1996;42:225-32 pubmed
  21. Andreatta van Leyen S, Averill D, Ferrario C. Cardiovascular actions of vasopressin at the ventrolateral medulla. Hypertension. 1990;15:I102-6 pubmed
    ..These experiments suggest that vasopressin stimulates the activity of vasomotor neurons in the rostral ventrolateral medulla by a mechanism that involves a neuronal V1 receptor. ..
  22. Leal A, Murphy M, Iwamoto G, Mitchell J, Smith S. A role for nitric oxide within the nucleus tractus solitarii in the development of muscle mechanoreflex dysfunction in hypertension. Exp Physiol. 2012;97:1292-304 pubmed publisher
    ..These findings support the contention that reductions in NO production within the NTS contribute to the generation of abnormal cardiovascular control by the skeletal muscle mechanoreflex in hypertension. ..
  23. Abdelrahman A, Pang C. Calcitonin gene-related peptide is a venous dilator in conscious rats. Eur J Pharmacol. 1992;217:185-9 pubmed
    ..In rats given noradrenaline, CGRP dose dependently decreased MAP, MCFP and increased HR. The results show that CGRP has venodilator activities; its venous effect is best revealed at elevated venous tone. ..
  24. Izumi H, Karita K. Vasodilator responses following intracranial stimulation of the trigeminal, facial and glossopharyngeal nerves in the cat gingiva. Brain Res. 1991;560:71-5 pubmed
  25. Jadcherla S. Inflammation inhibits muscarinic signaling in in vivo canine colonic circular smooth muscle cells. Pediatr Res. 2002;52:756-62 pubmed
    ..These findings suggest that changes in muscarinic response during colitis may contribute to the abnormal motility seen with inflammatory bowel disease. ..
  26. Diedrich A, Jordan J, Shannon J, Robertson D, Biaggioni I. Modulation of QT interval during autonomic nervous system blockade in humans. Circulation. 2002;106:2238-43 pubmed
    ..Patients with MSA have greater residual sympathetic tone and greater prolongation of the QT interval during ganglionic blockade than PAF patients. ..
  27. Kingma J, Simard D, Voisine P, Rouleau J. Role of the autonomic nervous system in cardioprotection by remote preconditioning in isoflurane-anaesthetized dogs. Cardiovasc Res. 2011;89:384-91 pubmed publisher
    ..We report robust myocardial protection by rIPC against ischaemic injury in canines that was not abrogated by either pharmacological or surgical decentralization of cardiac nerves. ..
  28. Niijima A, Kubo M, Ichiki H, Komatsu Y, Maruno M, Okada M. Effect of byakko-ka-ninjin-to on the efferent activity of the autonomic nerve fibers innervating the sublingual gland of the rat. J Auton Nerv Syst. 1997;63:46-50 pubmed
    ..v. administration of hypertonic saline was antagonized by intraduodenal infusion of BN. From these observations it is suggested that Byakko-ka-ninjin-to acts as a facilitatory agent on salivary secretion. ..
  29. Ma X, Abboud F, Chapleau M. A novel effect of angiotensin on renal sympathetic nerve activity in mice. J Hypertens. 2001;19:609-18 pubmed
    ..The mechanism may involve direct activation of post-ganglionic sympathetic neurons mediated through AT1 receptors. ..
  30. Takemoto Y. Possible contribution of central gamma-aminobutyric acid receptors to resting vascular tone in freely moving rats. Exp Physiol. 2000;85:479-85 pubmed
    ..Together, these findings suggest that central GABA receptors accessible from the cisterna magna preferentially affect two vascular beds which, in the freely moving rat, show resting autonomic vascular tone...
  31. Lezama L. Research guidelines: Hopkins deals with research volunteer death and aftermath. J Law Med Ethics. 2002;30:111-2 pubmed
  32. Martin D, Egland M, Barnes L, Vogel E. Adrenergic nerves mediate the venoconstrictor response to PVN stimulation. Brain Res. 2006;1076:93-100 pubmed
    ..These data indicate that adrenomedullary catecholamines are not necessary for full expression of the venoconstrictor response to PVN stimulation. ..
  33. Ya Deau J, Heerdt P, The A, Wang Q. Hemodynamic effects of di-sec-butyl phenol, an anesthetic substituted phenol. Pharmacology. 2006;76:117-22 pubmed
    ..4 +/- 1.7% vs. 3.5 +/- 0.3%). DSB produced age-dependent elevation of mean blood pressure in rabbits, probably by causing release of catecholamines from the sympathetic nervous system. ..
  34. Muratani H, Averill D, Ferrario C. Effect of angiotensin II in ventrolateral medulla of spontaneously hypertensive rats. Am J Physiol. 1991;260:R977-84 pubmed
    ..This study provides evidence that ANG II acts as an excitatory agent at sites within the ventrolateral medulla that determine the vasomotor control of blood pressure in both normotensive and hypertensive rats. ..
  35. Harris M, Ramaswamy K, Kennedy J. Induction of neurally mediated NaHCO3 secretion by luminal distension in rat ileum. Am J Physiol. 1989;257:G191-7 pubmed
    ..Atropine (0.5 mg/kg) had no effect. Our studies demonstrate that distension induces the secretion of Na and HCO3 by the intact ileum. This secretory process may represent a neurally rather than passively mediated mechanism. ..
  36. Glick M, Gehman J, Gascho J. Aging increases venous compliance in awake instrumented rats. Am J Physiol. 1993;264:H1948-52 pubmed
    ..28 +/- 0.21 vs. 2.63 +/- 0.12; P = 0.014). In this conscious instrumented rat model, baseline total venous compliance is increased in older rats. ..
  37. Houghtling R, Bayer B. Rapid elevation of plasma interleukin-6 by morphine is dependent on autonomic stimulation of adrenal gland. J Pharmacol Exp Ther. 2002;300:213-9 pubmed
    ..Collectively, these data suggest a unique mechanism by which stimulation of central opioid receptors results in the elevation of plasma IL-6 through autonomic activation specifically of the adrenal cortex...
  38. Jones P, Shapiro L, Keisling G, Jordan J, Shannon J, Quaife R, et al. Altered autonomic support of arterial blood pressure with age in healthy men. Circulation. 2001;104:2424-9 pubmed
    ..Basal sympathetic activity and alpha-adrenergic vascular sensitivity are also key physiological correlates of ANS support of BP in healthy men. ..
  39. Barnes J, Hart E, Curry T, Nicholson W, Eisenach J, Wallin B, et al. Aging enhances autonomic support of blood pressure in women. Hypertension. 2014;63:303-8 pubmed publisher
  40. Gherezghiher T, Hey J, Koss M. Parasympathetic nervous control of intraocular pressure. Exp Eye Res. 1990;50:457-62 pubmed
    ..5 x 10(-7) M) into the ONC produced a bilateral rise in IOP that lasted for more than 15 min. This increase in IOP was greater than 50% of control levels and was accompanied with miosis.(ABSTRACT TRUNCATED AT 250 WORDS) ..
  41. Luo Y, Zeng J, Yu M, Wei Y, Qu S, Li W, et al. Effect of rhubarb on contractile response of gallbladder smooth muscle strips isolated from guinea pigs. World J Gastroenterol. 2005;11:863-6 pubmed
    ..Rhubarb can stimulate the motility of isolated gallbladder muscle strips from guinea pigs. The stimulation of rhubarb might be relevant with M receptor, Ca(2+) channel and alpha receptor partly. ..
  42. Watanabe H, Ishii H, Niioka T, Yamamuro M, Izumi H. Occurrence of parasympathetic vasodilator fibers in the lower lip of the guinea-pig. J Comp Physiol B. 2008;178:297-305 pubmed
    ..The present study indicates the presence of parasympathetic vasodilator fibers originating from the otic parasympathetic ganglion in the guinea-pig lower lip, similar to those reported previously in rats, cats, rabbits and humans...
  43. Uchino M, Ishii K, Kuwahara M, Ebukuro S, Tsubone H. Role of autonomic nervous system for development and suppression of motion sickness in Suncus murinus. Auton Neurosci. 2001;94:46-51 pubmed
  44. Ma X, Sigmund C, Hingtgen S, Tian X, Davisson R, Abboud F, et al. Ganglionic action of angiotensin contributes to sympathetic activity in renin-angiotensinogen transgenic mice. Hypertension. 2004;43:312-6 pubmed
    ..The significant contribution of the direct ganglionic action of Ang II in R+A+ mice likely reflects both increased levels of Ang II and upregulation of AT1 receptors in sympathetic ganglia. ..
  45. Langley R, Kalra R, Mishra N, Sopori M. Central but not the peripheral action of cholinergic compounds suppresses the immune system. J Neuroimmunol. 2004;148:140-5 pubmed
    ..Thus, cholinergic agents affect the neuroimmune communication and inhibit glucocorticoid production; the latter may be a biomarker for cholinergic toxicity. ..
  46. Fedin A, Kriukova E, Nekrasova E. [Interactions of histamine and glucocorticoids with nerve structures of respiration passages]. Ross Fiziol Zh Im I M Sechenova. 2001;87:1413-21 pubmed
    ..This investigation involved study of the interaction mechanisms between histamine and dexamethasone, on one hand, and intramural neural structures, on the other hand. ..
  47. Porter J, King S. Prenatal high salt programs enhanced sympathoadrenal activation of the cardiovascular response to restraint. Auton Neurosci. 2009;150:140-3 pubmed publisher
    ..These data suggest that the prenatal high salt programmed a sympathoadrenal hyperresponsiveness to restraint stress...
  48. Wolfrum S, Schneider K, Heidbreder M, Nienstedt J, Dominiak P, Dendorfer A. Remote preconditioning protects the heart by activating myocardial PKCepsilon-isoform. Cardiovasc Res. 2002;55:583-9 pubmed
    ..0.78+/-0.06 in HEX+RPC). RPC activates myocardial PKCepsilon through a neuronal and bradykinin-dependent pathway. We assume that activation of PKCepsilon is an important step in cardioprotection induced by remote preconditioning. ..
  49. Skarlatos S, Metting P, Britton S. Spontaneous pressure-flow patterns in the kidney of conscious rats. Am J Physiol. 1993;265:H2151-9 pubmed
    ..These results indicate that, in the resting conscious undisturbed state, the autonomic nervous system exerts a tonic influence on the renal circulation that facilitates arterial pressure regulation via a baroreflex-like pattern. ..
  50. Morikawa K, Aratani T, Mizutani F, Kato H, Ito Y. [Evaluation of tiquizium bromide (HSR-902) as an antiulcer agent]. Nihon Yakurigaku Zasshi. 1987;90:273-83 pubmed
    ..o.) induced the mydoriasis and inhibited the pilocarpine-induced salivation, and its activities were less potent than those of pirenzepine. These results suggest that HSR-902 is a promising agent for the treatment of peptic ulcer. ..
  51. Ghia J, Blennerhassett P, Kumar Ondiveeran H, Verdu E, Collins S. The vagus nerve: a tonic inhibitory influence associated with inflammatory bowel disease in a murine model. Gastroenterology. 2006;131:1122-30 pubmed
    ..The identification of a counterinflammatory neural pathway would open new therapeutic avenues for treating acute exacerbations of inflammatory bowel disease. ..
  52. Cheung C. Fetal adrenal medulla catecholamine response to hypoxia-direct and neural components. Am J Physiol. 1990;258:R1340-6 pubmed
    ..In contrast, at 130 days gestation the response to hypoxia is entirely neurally mediated. Thus neural innervation to the ovine fetal adrenal medulla matures before 110 days gestation, much earlier than previously reported. ..
  53. Benoussaidh A, Maurin Y, Rampin O. Spinal effects of oxytocin on uterine motility in anesthetized rats. Am J Physiol Regul Integr Comp Physiol. 2004;287:R446-53 pubmed
    ..These results support our hypothesis that oxytocin released by descending paraventriculo-spinal pathways and acting on spinal oxytocin receptors modulates the activity of the uterus. This regulation is cycle dependent. ..