Local Transdermal Glyceryl Trinitrate Has an Antiinflammatory Action on Thrombophlebitis Induced by Sclerosis of Leg Varicose Veins

Abstract

To test the antiinflammatory and analgesic effects of transdermal glyceryl trinitrate (GTN) the authors carried out a double-blind, randomized, controlled clinical study in 21 patients with mild to moderate leg varicose veins who underwent vein sclerotherapy in both legs. GTN or placebo ointment was applied in a blinded protocol along the surface of the sclerosed vein every eight hours until disappearance of inflammation signs. The varicose vein in one leg was treated with GTN and compared with placebo for the vein of the other leg used as control of thrombophlebitis (TP) signs. Fifteen minutes after first application inflammation signs were observed in all cases. The intensity of inflammation signs was assessed as 26% (10.4 +/- 4.1) in GTN-treated veins and as 61.5% (24.6 +/- 6.3) (P < 0.001) in the placebo-treated veins. One hour later only 63% of cases in the GTN group and all cases in the placebo group showed signs of TP (P < 0.001). The reduction in the intensity of signs at this time was 7.7 +/- 3.9 in the GTN group and 19.7 +/- 6.3 in the placebo group (P < 0.001). All veins in the GTN group were free of signs of TP in less than forty-eight hours. In the placebo group, 45% of veins required more than forty-eight hours for complete disappearance of signs of TP (P < 0.001). The authors conclude that GTN has an antiinflammatory effect in TP induced by sclerotherapy. This action may be related to the nitric oxide released from GTN, through a direct action on the vein and the surrounding inflamed tissue.

Efficacy of transdermal nitroglycerin combined with etodolac for the treatment of chronic post-thoracotomy pain: An open-label prospective clinical trial

“…20 The clinical efficacy of transdermal NTG for acute pain relief has been documented in several studies. NTG was found to be useful for the treatment of shoulder pain, 8 for reducing oral analgesic requirements in patients with pain due to thrombophlebitis, 21,22 and for enhancing the effect of spinal sufentanil for postoperative analgesia. 9 Transdermal formulations of NTG have several advantages for chronic use: simplicity of administration, lack of variability in drug availability due to differences in gastrointestinal absorption, and lack of gastrointestinal irritation.…”

Anti-inflammatory and Anti-nociceptive Activity of Ruthenium Complexes with Isonicotinic and Nicotinic Acids (Niacin) as Ligands

“…Different classes of NO donor substances also block ongoing PGE- or noxious stimuli-induced hyperalgesia in experimental animals. ,− Moreover, in human volunteers, glyceryl trinitrate reduces the pain caused by vein sclerotherapy in the legs and controls pain in women with severe dysmenorrhea. , Recently, Hervera demonstrated that nitric oxide donors could potentiate the peripheral anti-nociceptive effect of a delta-opioid receptor agonist (DOR) with complete Freund’s adjuvant (CFA)-induced inflammatory pain, which indicates a new strategy for the treatment of peripheral inflammatory pain via an increase in the analgesic effects of opioids. In fact, transdermal nitroglycerin has been used as a coadjuvant in opiate therapy for cancer pain control …”

The analgesic effect of three different doses of nitroglycerine when added to lidocaine for intravenous regional anesthesia in trauma patients

“…In addition, NO generators induce antiinflammatory effects and analgesia by blocking hyperalgesia and the neurogenic component of inflammatory edema with topical application. [16,17] An additional possible mechanism includes an analgesic effect through the direct stimulation of peripheral fibers imitating the actions of locally applied acetylcholine. [18] Ultimately, molecular pharmacology modulation may be suggested for the mechanism of synergistic interaction between µ-opioid receptors and NO.…”