Cyclic AMP-dependent and independent positive inotropic effects of phenylephrine.

To summarize, a large number of studies indicate that the effects of phenylephrine on cardiac contractility are mediated through alpha-adrenoceptors, although not exclusively. There are an equally large number of reports indicating some beta-adrenoceptor stimulant effects of phenylephrine. Of the latter, some are based on the finding of antagonism by beta-receptor antagonists and some on the fact that phenylephrine is capable of elevating cyclic AMP levels, which is primarily a beta-, and not alpha-adrenoceptor effect. Although it is now widely accepted that phenylephrine elevates cyclic AMP levels, the contribution and significance of the elevated nucleotide levels to the overall positive inotropy of phenylephrine appears to be small. Alpha-Adrenoceptors may be involved with calcium, although the precise interaction between calcium and the alpha-adrenoceptor is not clear. Finally, the adrenergic effects seem to depend on the experimental and physiological conditions including calcium ion concentration, thyroid state and driving frequency.