Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Nitroglycerin”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed1991

A comparison of buccal nitroglycerin and sublingual nitroglycerin in the prophylaxis and treatment of exertional (situation-provoked) angina pectoris.

Suscard is a buccally administered formulation which provides rapid introduction of nitroglycerin directly into the systemic circulation and, by virtue of its sustained-release properties, may confer protection against anginal attacks for several hours. Its efficacy has been established in angina pectoris and more recently its usefulness has been extended to include the management of unstable angina and acute heart failure. Buccal nitroglycerin combines the possibilities of short-term treatment and more extended prophylaxis. In a multicentre double-blind study the efficacy of buccal nitroglycerin and sublingual nitroglycerin were compared in patients with proven chronic stable exercise-induced angina as regards anginal attacks and capacity for physical activity. The conclusion is that the two formulations of nitroglycerin have a comparable effect in the treatment of acute attacks of angina pectoris. Buccal nitroglycerin has many advantages when used prophylactically. This is documented by less frequent anginal attacks and a more prolonged duration of effect resulting in an increased physical activity.

Administration, Buccal↗
PubMed1995

Effects of intravenous nitroglycerin and nitroglycerin and metoclopramide on intravariceal pressure: a double blind, randomized study.

OBJECTIVE: Effective and safe reduction of variceal pressure by pharmacological means. METHODS: Twenty patients with portal hypertension and large esophageal varices. Ten patients received i.v. nitroglycerin (300 micrograms-bolus) and an equal number received a combination of i.v. nitroglycerin (150 micrograms) and metoclopramide (20-mg bolus). Continuous measurement of variceal pressure and systemic hemodynamics was carried out. RESULTS: Compared with the baseline, the variceal pressure was reduced at 10 min after injection of 300 micrograms nitroglycerin (22.3 +/- 7.9 vs. 17.3 +/- 7 mm Hg, p, not significant); the percentage reduction was 23.5 +/- 15.8%. With the combination of low dose (150 micrograms) nitroglycerin and metoclopramide, variceal pressure significantly decreased from 23.1 +/- 4.7 to 15.9 +/- 5.9 mm Hg (p < 0.01) (a reduction of 29.5 +/- 24.1%). There was no significant alteration in the heart rate or mean arterial pressure with either regimen. CONCLUSIONS: Our results suggest that a combination of i.v. metoclopramide and low-dose nitroglycerin reduces variceal pressure more effectively than high-dose nitroglycerin used alone. This combination should be further evaluated in the control of acute variceal bleeding.

Adolescent↗
PubMed1991

Acute and chronic antianginal efficacy of continuous twenty-four-hour application of transdermal nitroglycerin. Steering Committee, Transdermal Nitroglycerin Cooperative Study.

To resolve the controversies surrounding the antianginal use of chronic, continuous 24-hour transdermal nitroglycerin therapy, a double-blind, placebo-controlled, randomized, parallel-group study was designed. Eligible patients had chronic angina pectoris with symptom-limited, reproducible treadmill tests and were responsive to sublingual nitroglycerin (n = 562). Patients were randomly assigned to placebo or 1 of 7 doses of active treatment (15, 30, 45, 60, 75, 90 and 105 mg/24 hours). In the active drug groups, treatment was initiated with 15 mg/24 hours during the first week of double-blind dosing with subsequent weekly increases until the assigned dose was reached, after which the dose was held constant. Treadmill tests were performed 0, 4 and 24 hours after the initial double-blind patches were applied, after each titration step and after 8 weeks. At the end of double-blind therapy, a sublingual nitroglycerin exercise challenge was repeated. Exercise tolerance in patients using the active patch increased 34 seconds (p less than 0.05) over patients taking placebo 4 hours after the initial application of double-blind therapy, but there was no statistically significant difference in exercise time between placebo and active drug groups by 24 hours after the first application or for the remaining 8 weeks of the trial. Increasing the dose did not overcome the loss of effect. A partial attenuation of the response to a sublingual nitroglycerin challenge seen on exercise tolerance testing also occurred, with patients who received the highest dose showing the greatest attenuation. There were no differences in angina frequency among the groups, although in a post hoc analysis, patients with greater than 7 attacks per week had a reduction in anginal frequency of 6 to 7 attacks per week with active treatment versus 2 attacks per week with placebo. The study showed that (1) tolerance to the exercise effects of continuous transdermal nitroglycerin develops within 24 hours after application; and (2) increasing the dose does not overcome this tolerance. The observation that symptomatic improvement may occur in the absence of increases in exercise tolerance seems deserving of further study.

Administration, Cutaneous↗
PubMed1980

Nitroglycerin prophylaxis in angina pectoris. Effect of sustained release nitroglycerin capsules on anginal frequency and exercise capacity.

Since the pharmacological effects of sublingual nitroglycerin are of short duration, attempts have been made over a number of years to prolong the activity of nitroglycerin by various means, viz. : (1) topical applications of nitroglycerin ointments, relying upon percutaneous absorption; (2) changes in chemical structure leading to such derivatives as isosorbide dinitrate or pentaerythritol tetranitrate; and (3) development of pharmaceutical preparations devised to disintegrate slowly, thus releasing the active substance over a long period. The purpose of the present study was to determine the effects of such a sustained-release nitroglycerin preparation on the frequency of painful paroxysms and on exercise capacity in patients with angina pectoris. In a double-blind trial comparing the preparation with a placebo 25 patients were observed during 24 weeks. The active substance significantly reduced the number of anginal attacks and increased exercise capacity in all cases. It would therefore seem that sustained-release nitroglycerin capsules deserve to have a place in the treatment of angor pectoris. However, further studies involving a larger number of patients are required to support these conclusions.

Angina Pectoris↗
PubMed1987

Comparison of nitroglycerin-TTS and long-acting nitroglycerin tablets in the treatment of angina pectoris: a double-blind controlled study.

A cohort of 99 patients with severe, stable angina pectoris participated in a 26-week double-blind, between-patient trial of a transdermal therapeutic system (TTS) Nitroglycerin-TTS 5 mg/24 h and long-acting nitroglycerin tablets, 10.4 mg daily. The variables registered included daily sublingual nitroglycerin requirement, daily anginal attack rate, exercise test performance with ECG recordings, and a subjective patient evaluation on a visual analogue scale. There were no significant differences in the efficacy of the treatment between the two groups. Nor could we find any difference in the efficacy between the initial single-blind placebo treatment and the active nitroglycerin treatments.

Administration, Cutaneous↗
PubMed1999

Head-up tilt testing potentiated with oral nitroglycerin: a randomized trial of the contribution of a drug-free phase and a nitroglycerin phase in the diagnosis of neurally mediated syncope.

BACKGROUND: Since the pharmacological challenge with nitroglycerin (NTG) follows the initial drug-free phase in current tilt testing protocols, the effects of nitroglycerin alone and the appropriate duration of the basal phase are unknown. METHODS: To optimize the test, a randomized intra-patient comparison of two protocols was undertaken: a conventional nitroglycerin test (cHUT) consisting of passive upright posture at 60 degrees for 45 min followed, if negative, by sublingual NTG 0.4 mg spray, with the test continued for 20 min; and, accelerated nitroglycerin test (aHUT) consisting of passive upright posture at 60 degrees for 5 min--to rule out orthostatic hypotension--followed by sublingual NTG 0.4 mg spray, with the test continued for 20 min. Eighty-four consecutive patients (33 males; mean age 55+/-22) with unexplained syncope underwent both cHUT and aHUT in a randomized sequence with a 24-72 h interval between them. Additionally, 25 age-matched control subjects underwent aHUT. RESULTS: In the drug-free phase, cHUT was positive in 15/84 patients (18%) and aHUT in 1/84 patients (1%). After NTG, cHUT and aHUT showed the same positivity rate of 33% (28/84 patients). The overall positivity rate was therefore higher with cHUT than with aHUT (51% vs 35%, P=0.04). Times to syncope were 29+/-12 min, (range 2-44) for cHUT drug-free phase, 5+/-2 min (range 2-9) for cHUT NTG phase, and 5+/-2 min (range 2-9) for aHUT. Only one (4%) of the control subjects had a positive response to aHUT. CONCLUSIONS: The contribution of NTG to the diagnosis is independent of the presence of an unmedicated phase. The appropriate duration of the NTG phase is 10 min. aHUT has good specificity, but a positivity rate lower than cHUT; thus a drug-free phase is necessary to increase the sensitivity of the test.

Administration, Oral↗
PubMed1993

[Intranasal administration of nitroglycerin solution and nitroglycerin spray during general anesthesia].

Nitroglycerin spray is a newly developed nitroglycerin (TNG) form, which delivers 0.3 mg of TNG with each spray emission. We compared the efficacy of intranasal administration of TNG spray and that of TNG solution during general anesthesia. Nineteen patients were randomly assigned to receive either 0.3 mg TNG solution (Solution group) or 0.3 mg TNG spray (Spray group) intranasally. Peak elevation of plasma TNG occurred 2 min after drug administration in both groups, and the plasma level decreased to an ineffective level after 10 min. The plasma TNG of the spray group was significantly higher than that of the solution group for 3 min. Two min after drug administration, systolic blood pressure decreased significantly in both groups, and this level persisted for 10 min. Diastolic blood pressure also decreased in the spray group, but not in the solution group. Heart rate increased significantly in both groups 2 min after drug administration. Oxygen index (PaO2/FIO2) decreased significantly in both groups, and the level persisted 10 min after administration. Although no significant differences were found between two nitroglycerin forms in any of these hemodynamic and respiratory parameters, nitroglycerin spray may have clinical advantages because of reliability in its effect, ready availability, ease of application and high stability.

Administration, Intranasal↗
PubMed1993

[The peripheral analgesic action of the exogenous nitric oxide donor: nitroglycerin. A placebo-controlled study of the transdermal action of nitroglycerin on pain sensitivity in the forearm].

Nitric oxide is a biological mediator. In nervous system it acts like neurotransmitter and also modulate acute inflammation. In the peripheral nervous system it blocks the nociceptive stimulus through an increase in postsynaptic neurone GMPc level. Nitro-vasodilator drugs like nitroglycerin are metabolised in the cell given rise to short lived intermediates, which liberating nitric oxide that activate the guanylate cyclase enzyme, increasing the GMPc in smooth muscle cell. This study show that nitroglycerin produces an analgesic action. The pain sensitivity to pinprick test in forearm with nitroglycerin has shown a decrease in a significative manner against placebo. We speculate that nitroglycerin could have a similar action as endogenous nitric oxide in nervous system.

Administration, Cutaneous↗
PubMed1993

Nitroglycerin dinitrate metabolites do not affect the pharmacokinetics and pharmacodynamics of nitroglycerin in the dog: a preliminary report.

Studies were carried out in conscious dogs to determine the effects of 1,2-glyceryl dinitrate (1,2-GDN) and 1,3-glyceryl dinitrate (1,3-GDN) on nitroglycerin (GTN) pharmacokinetics and pharmacodynamics. In the first set of experiments, steady state plasma levels (Css) of either 1,2-GDN or 1,3-GDN in three dogs were rapidly achieved by giving an iv bolus (77 micrograms/kg), followed immediately by an infusion (50 micrograms/min) of the same GDN. A single iv bolus dose of GTN (0.025 micrograms/kg) was given 50 min after beginning the GDN infusion and compared with plasma concentrations following a similar GTN dose in the absence of dosed GDNs. No significant differences in GTN AUC (p > 0.9) and CL(app) (p > 0.7) were found. In a second set of experiments, an infusion of nitroglycerin was begun in each of 4 dogs and continued for 160 min at an infusion rate of 100 micrograms/min. Steady state concentrations of GTN were achieved within 100 min, at which time the dog received, simultaneously, an iv bolus dose (5.14 mg) of one of the GDNs and an infusion dose (100 micrograms/min) of the same GDN. For both dinitrate metabolites no significant differences (p > 0.5) were found between control and interaction arterial and venous clearances, although venous GTN clearances tended to decrease in the presence of dosed GDNs. Steady state systolic blood pressure during GDN infusions could be further reduced when GTN doses were administered; however, the steady state systolic blood pressure decrease caused by GTN could not be further reduced by the GDN infusions. Results suggest that the GDNs do not inhibit nitroglycerin metabolism or hemodynamics at the dose levels studied here.

Animals↗
PubMed1992

Heating and cooling of the nitroglycerin patch application area modify the plasma level of nitroglycerin.

19 healthy volunteers wore a nitroglycerin patch releasing 10 mg per 24 h for 2 h. Subsequently, the skin area surrounding the patch was exposed to 15 min of local heating with an infrared bulb (Group A, n = 10), or local cooling with an ice-pack (Group B, n = 9). The patch was protected by an insulating shield (Styrofoam). After 10 min of heating, the median (Walsh) plasma nitroglycerin level increased from 3.1 to 7.6 nmol.l-1. Body temperature remained constant. After 15 min of cooling the median plasma level had dropped from 2.1 to 1.4 nmol.l-1. The results demonstrate that changes in skin temperature may cause extensive short-term changes in the bioavailability of nitroglycerin. Presumably, a subcutaneous or cutaneous reservoir builds up during transdermal treatment, and changes in regional cutaneous blood flow affect the rate of drainage from the reservoir into the systemic circulation.

Administration, Cutaneous↗
PubMed1998

Design of a randomized, placebo-controlled multicenter trial on the long-term effects of intermittent transdermal nitroglycerin on left ventricular remodeling after acute myocardial infarction. Transdermal Nitroglycerin Investigators Group.

Nitrates are widely used in the treatment of patients with ischemic heart disease and in those with angina following acute myocardial infarction. Short-term studies indicate that the administration of nitrates may prevent left ventricular (LV) dilation and infarct expansion. Animal models suggest that prolonged nitroglycerin use after infarction may limit LV remodeling similar to that observed with angiotensin-converting enzyme inhibitors. However, to date there have been no trials evaluating the effects of nitrates on LV volumes in patients surviving acute myocardial infarction. We therefore performed a randomized double-blind, placebo-controlled trial designed to investigate the long-term (6 month) efficacy of intermittent transdermal nitroglycerin patches on LV remodeling in 291 survivors of acute myocardial infarction. Patients were randomized to receive either placebo or a nitroglycerin patch that delivered 0.4, 0.8, or 1.6 mg/hour. Gated radionuclide angiography was used to assess serial changes in LV ejection and cardiac volumes. The baseline characteristics of the study population were similar in all 4 treatment groups. The study protocol and the main design-related issues are described.

Administration, Cutaneous↗
PubMed2003

A prospective, randomized, controlled trial of benzodiazepines and nitroglycerine or nitroglycerine alone in the treatment of cocaine-associated acute coronary syndromes.

The purpose of the present study was to compare the use of lorazepam plus nitroglycerine (NTG) versus NTG alone in the reduction of cocaine induced chest pain in the emergency department. The secondary objective of the study was to help determine the safety of lorazepam in the treatment of cocaine- associated chest pain. The study was a prospective, randomized, single-blinded, controlled trial conducted at an university-affiliated urban emergency department (ED). All patients who presented with cocaine-associated chest pain were enrolled. Exclusion criteria included age greater than 45 years, documented coronary artery disease, chest pain of more than 72 hours duration, or pretreatment with nitroglycerin. Patients were given either sublingual nitroglycerine (SL NTG) (Group 1) or SL NTG plus 1 mg of lorazepam intravenously (Group 2) every 5 minutes for a total of 2 doses. Chest pain was recorded on an ordinal scale of 0 to 10 at baseline, and then at 5 minutes after each dose. Adverse reactions to medication were also recorded. Twenty-seven patients met the inclusion criteria and were enrolled in the study. The average age of these subjects was 34.1 years, and 67% were men. The NTG-only group consisted of 15 patients and the NTG-plus-lorazepam group consisted of 12 patients. Baseline mean chest-pain scores were 6.87 in Group 1 and 6.54 in Group 2, with no differences between groups. Five minutes after initial treatment, mean scores for the two groups were 5.2 and 3.9, respectively, with a difference in means of 1.24 (95% confidence interval [CI] -0.8-3.8). Five minutes after the second treatment, the mean scores were 4.6 and 1.5, respectively, with a difference in means of 3.1 (95% CI 1.2-5). Kruskal-Wallis testing showed a significant difference in pain relief between the two study groups (P =.003), with greater pain relief noted at 5 and 10 minutes in the NTG-plus-lorazepam group (P =.02 and P =.005, respectively). All patients in the study were admitted to the hospital, but no patient in either group had an acute myocardial infarction or cardiac complications in the ED. No adverse side effects were noted for either group. The early use of lorazepam with NTG was more efficacious than NTG alone, and appears to be safe in relieving cocaine-associated chest pain.

Acute Disease↗
PubMed1990

Hemodynamic comparison of combined therapy by nitroglycerin tape and ibopamine with combination of nitroglycerin tape and nifedipine.

Fifteen congestive heart failure patients (NYHA: class III or IV) were enrolled in the study and were classified into two groups. Six patients (group I) received combined therapy by nitroglycerin tape (5 mg) and ibopamine (100 mg), while the remaining 9 patients (group II) were given nitroglycerin tape (5 mg) and nifedipine (10 mg). The effects of the combined treatments on hemodynamics were compared between the two groups using Swan-Ganz catheter method. No significant differences were noted in the hemodynamic baseline values of the two groups before treatment. In group I mean pulmonary arterial pressure (mPA) and systemic vascular resistance (SVR) decreased and the cardiac index (CI) increased, while the heart rate (HR) and mean blood pressure (mBP) remained unchanged. In group II mBP, mPA and SVR were lowered, whereas CI and HR were augmented. There were no significant differences between the two groups with respect to mPA and CI. However, mBP decreased in group II, while it remained unchanged in group I, with significant difference between the two groups (p less than 0.01). Preload and afterload, on the base of mPA and SVR, respectively, decreased in both groups, while cardiac output increased, suggesting that both treatments were useful for the improvement of cardiac output. Mean BP decreased in group II, although it remained unchanged in group I. These results suggest that the combination of nitroglycerin and ibopamine may be more useful in hypotensive patients with heart failure.

Administration, Cutaneous↗
PubMed1988

Plasma nitroglycerin levels, blood pressure and apical heart rate variations to site of application of nitroglycerin ointment.

The purpose of this study was to observe changes in plasma nitroglycerin levels, systolic and diastolic blood pressure, and apical heart rate after the administration of nitroglycerin ointment to selected sites. The sample consisted of 15 subjects with a diagnosis of coronary artery disease. The four application sites used were the fifth intercostal space of the left anterior chest, medial aspect of the left upper arm, medial aspect of the left thigh, and medial aspect of the left lower leg. There was no statistically significant difference in plasma nitroglycerin levels and diastolic blood pressure to site of application. Mean systolic blood pressure was significantly lower (p less than 0.05) for the upper arm and anterior chest sites than for the thigh and ankle at both 75 and 90 minutes. Mean heart rate was significantly higher (p less than 0.05) for the anterior chest than for the ankle at 45 and 60 minutes.

Adult↗
PubMed1980

[Preventive action on stable exercise-induced angina of a topical nitroglycerin gel and of an oral slow-release nitroglycerin compound (Lénitral) in low and high dosage (author's transl)].

A nitroglycerin gel applied to the skin in doses of 15 to 30 mg prevents or delays the anginal pain induced by an excise tolerance test. The effects of the drug after a single application lasted 3 hours irrespective of the dose. Improvement in terms of increased heart rate, decreased S-T segment displacement and increased exercise capacity was the same as that observed after 0,75 mg sublingual nitroglycerin. A single 2.5 mg dose of an oral compound slowly released from the intestine (Lénitral) had no measurable effect during a 3-hour observation period. In contrast, a single 7.5 mg dose of the same compound produced, after 3 hours, the same overall improvement as that obtained with 0.75 mg sublingual nitroglycerin.

Administration, Oral↗
PubMed1976

[Effect of nitroglycerin in acute myocardial infarction. II.Intravenous infusion of nitroglycerin in patients with or without left-heart failure, and its effect on infarct size (author's transl)].

Twenty-four patients with acute myocardial infarction were divided into two groups according to left-ventricular filling pressure (LVFP): group I (n = 13) with LVFP less than 20 mm Hg, group II (n = 11) with LVFP greater than 20 mm HG. After infusion of 3 mg nitroglycerin in the first and 6 mg in the second hour there was a highly significant decrease in the filling pressure (from 15 to 9 mm Hg in group I, 28 to 16 mm Hg in group II). Mean arterila pressure fell in both groups by an average of 9 mm Hg. There were only slight changes in heart rate. Cardiac output fell from 4.4 to 3.9 1/min in group I, while it rose significantly (from 3.5 to 4.0 1/min) in group II from an initially markedly decreased level. In patients of group II the subjective symptoms improved with positive changes in the haemodynamic variables. Electrocardiographic precordial mapping indicated that nitromapping indicated that nitroglycerin at a dose of 3 mg/h diminished the zone of ischaemia, while at a dose of 6 mg/h S-T elevations and depressions increased again.

Acute Disease↗
PubMed1975

[Effect of nitroglycerine in acute myocardial infarction: I: Sublingual nitroglycerine in the treatment of left-heart failure and pulmonary oedema (author's transl)].

In 15 patients with left ventricular failure, ten with recent myocardial infarction and five with old infarct a highly significant fall in pulmonary-artery pressure occurred within 3-5 minutes of sublingual administration of nitroglycerine, 0.8 and 1.6 mg. End-diastolic pulmonary-artery pressure, as an expression of left ventricular filling pressure, fell from 25 plus or minus 8 to 17 plus or minus 8 mm Hg (P smaller than 0.001). In some patients cardiac output rose markedly, while arterial blood pressure fell only slightly (not statistically significant). In six patients with pulmonary oedema there was a decrease in dyspnoea within a few minutes. Left-ventricular filling pressure fell markedly in all cases, in one patient from 50 to 27 mm Hg. This study indicates that nitroglycerine can be effective in the treatment of left-ventricular failure of various causes.

Acute Disease↗
PubMed1975

Effects of nitroglycerin and nitroglycerin-methoxamine during acute myocardial ischemia in dogs with pre-existing multivessel coronary occlusive disease.

Nitroglycerin (TNG) reduces ischemic injury during acute coronary occlusion in dogs with otherwise normal coronary arteries, but its effect in the presence of pre-existing multivessel coronary disease is unknown. We therefore examined the influence of TNG on acute ischemia in dogs with chronic multivessel coronary occlusions. The left anterior descending (LAD) coronary artery was acutely occluded by a balloon cuff in conscious dogs two weeks after placement of ameroid constrictors to produce gradual occlusion of the obtuse marginal and posterior descending coronary arteries. Adequacy of balloon and ameroid coronary occlusion and degree of collateralization were assessed by coronary angiography. Nitroglycerin decreased arterial pressure and increased heart rate. Myocardial ischemia, determined after LAD occlusion by summing ST-segment elevation (sigmaST) from eight intramyocardial electrodes, lessened with TNG in those six dogs whose heart rate increased less than 50 per cent, but increased in those four whose heart rate increased greater than 50 per cent. When TNG-induced change in either heart rate or arterial pressure was prevented by adding methoxamine, sigma ST was diminished even more (avg decrease 25 per cent; P smaller than 0.05). We conclude that, in the presence of pre-existing multivessel coronary occlusions, 1) TNG reduces ischemic injury during experimental acute coronary occlusion provided arterial pressure and heart rate responses are not excessive and 2) uniform improvement occurs when pressure and rate responses are abolished by an alpha-adrenergic agonist. Although results in animal studies must be extrapolated to the clinical situation with caution, these findings suggest that a similar pharmacologic approach might be applicable to the treatment of acute myocardial infarction in man, even in the presence of multivessel disease.

Animals↗