Abstract The acute hemodynamic effects of pirmenol and lidocaine were studied in a double-blind, placebo-controlled investigation. Thirty patients undergoing catheterization received one of the following: pirmenol as a 50-mg intravenous bolus injection followed by a 2.5 mg/min infusion, lidocaine as a 75-mg intravenous bolus injection followed by a 3 mg/min infusion or placebo administered in a similar fashion. Mean plasma pirmenol concentrations during steady infusion were 2.3 to 2.4 mg/liter, and mean plasma lidocaine concentrations were 16 to 24 μmol/liter. Pirmenol increased heart rate from baseline by 10 beats/min (p < 0.001) and mean arterial pressure by 5 mm Hg (p < 0.001), with similar increases in systemic (p < 0.05) and pulmonary vascular resistance (p < 0.01). Lidocaine induced a comparable increase in mean arterial pressure (6 mm Hg, p < 0.001), but unlike pirmenol, it increased left ventricular and diastolic pressure by 2.8 mm Hg (p < 0.05). Indexes of left ventricular work were not affected by either drug. Echocardiographic ejection fraction was reduced more by pirmenol (−0.05, p < 0.0001) than by lidocaine (−0.03, p < 0.05), a difference that may be related to the changes in heart rate. Side effects were not observed in any patient. The myocardial depressant effect of pirmenol is relatively slight and comparable to that of lidocaine.