Use of Nitroglycerin Ointment in Congestive Heart Failure

Chandraratna, P.A.N.; Langevin, E.; Odell, Roger C.; Rubenstein, Carl J.; Pedro, S.B. San

doi:10.1159/000169914

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…It was shown that both the hemodynamic and clinically beneficial effects of NTG ointment start within 30 min and last for at least 7 hours after application. The duration of action of NTG ointment in angina pectoris thus seems to be of the same order as in patients with congestive heart failure (2, 10,15). This also in agreement with recent pharmacokinetic studies on NTG ointment (2, 3, 16).…”

Section: Discussionsupporting

confidence: 87%

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Nitroglycerin Ointment Effective for Seven Hours in Severe Angina Pectoris

Kala¹,

Hirvonen²,

Gordin³

et al. 1983

Journal of Internal Medicine

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The efficacy and tolerability of nitroglycerin (NTG) ointment were studied in 80 male patients with severe angina pectoris. Two symptom‐limited exercise tests were performed on successive days after application of an ointment containing 15 mg NTG or a placebo (P) ointment. The patients were assigned to 4 groups. The study was conducted in a double‐blind, cross‐over manner. The total amount of work performed was higher in all groups on NTG (46–70%) compared to P ointment. The difference was statistically significant (p<0.001) at all points of time from 0.5 to 7 hours. The ST segment depression in ECG at the end of the exercise test was slightly greater on P than on NTG, but the difference was statistically significant only in the 3‐hour group (p<0.01). The frequencies of headache and dizziness were 35% and 16%, respectively, on NTG. Eight patients (10%) reported that headache was severe enough to prevent regular use of NTG ointment. NTG ointment is effective, has a long duration of action and is relatively well tolerated by patients with severe angina pectoris.

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Section: Discussionsupporting

confidence: 87%

“…In 10 patients with anginal pain at rest, the number of attacks was significantly reduced compared to placebo with a dosing interval of 6 hours (9). In congestive heart failure, the hemodynamic effects of NTG ointment last for &7 hours (2,(10)(11)(12)(13)(14)(15).…”

mentioning

confidence: 99%

Nitroglycerin Ointment Effective for Seven Hours in Severe Angina Pectoris

Kala¹,

Hirvonen²,

Gordin³

et al. 1983

Journal of Internal Medicine

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show abstract

“…Several studies have shown that nitroglycerin ointment has prolonged beneficial effects in the treatment of congestive cardiac failure (Chandraatna & Langerin, 1978;Hardarson et al, 1979;Franciosa et al, 1977). Armstrong et al (1980) has recently shown that application of GTN ointment significantly reduces pulmonary capillary wedge pressure for at least 240 min, and in some cases for up to 480 min.…”

Section: Discussionmentioning

confidence: 99%

Sustained anti‐anginal action of glyceryl trinitrate cream.

Bennett¹,

Davies²,

Davis³

1983

Brit J Clinical Pharma

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1 In an acute study, 45 min following topical application of 9.2 mg of nitroglycerin (GTN) cream, exercise time increased by 100s (P < 0.005) and this increase persisted for 270 min. Systolic blood pressure showed a progressive fall. 2 In the second study 1 h following application of 9.2 mg GTN cream, a significant reduction in left ventricular diastolic dimension was seen. 3 In a subsequent chronic randomised double blind study, exercise time increased by 47 s (P < 0.05) at 6 h, following 3 weeks continual use. 4 An increased dose for a further 3 weeks produced no further increase in exercise time; however, a significant decrease in left ventricular end diastolic dimension was seen. 5 No evidence of pharmacological tolerance was seen, as patients continued to show a maximal response to sublingual nitroglycerin during the course of the study.

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“…Beyond the conventional administration routes and formulations, studies have been conducted to identify options with similar e cacy that can be easily administered. For human cardiac disease, these studies have led to the development of the sildena l citrate sublingual tablet to treat pulmonary arterial hypertension, nitroglycerin ointment to treat CHF, transdermal tulobuterol patch for bronchodilation, and transdermal beta-blocker (bisoprolol) patch to reduce postoperative atrial brillation (19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics and Diuretic Effect of Furosemide after Single Intravenous, Oral Tablet, and Newly Developed Oral Disintegrating Film Administration in Healthy Beagle Dogs

Koh

Jeong

Choi

et al. 2021

Preprint

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Background: Furosemide, a diuretic that acts on the loop of Henle, is commonly used to treat congestive heart failure in veterinary medicine. Some owners have difficulty in administering oral tablet medication to animal patients, which leads to noncompliance, especially during long-term administration. The oral disintegrating film (ODF) has the advantages of easy administration via a non-invasive route, rapid dissolution, and low suffocating risk. The objective of this study was to research the pharmacokinetic and pharmacodynamics (PK/PD) profiles of furosemide after intravenous (IV), orally uncoated tablet (OUT), and newly developed ODF administration in healthy beagle dogs. In this study, a furosemide-loaded ODF (FS-ODF) formulation was developed and five beagle dogs were administered a single dose (2 mg/kg) of furosemide via each route using a cross-over design.Results: The most suitable film-forming agent was sodium alginate; thus, this was used to develop an ODF for easy drug administration. No significant differences were detected in the PK profiles between OUT and FS-ODF. The maximum plasma concentration of furosemide was higher and the elimination half-life and time at maximum concentration were slightly lower after FS-ODF administration than after OUT administration. In the blood profiles, the concentration of total protein was significantly increased compared to the baseline (0 h), whereas no significant difference was detected in the concentration of creatinine and hematocrit compared to the baseline. FS-ODF resulted in a similar hourly urinary output to OUT during the initial 2 h after administration. The urine specific gravity was significantly decreased compared to the baseline in each group. The peak times of urine electrolyte (sodium and chloride) excretion per hour were 1 h (IV), 2 h (OUT), and 2 h (FS-ODF). Conclusions: These results suggest that the PK/PD of furosemide after administration of newly developed FS-ODF are similar to those of OUT in healthy dogs. Therefore, the ODF formulation has the benefits of ease and convenience, which would be helpful to owners of companion animals, such as small dogs (<10 kg) or cats, for the management of congestive heart failure.

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Use of Nitroglycerin Ointment in Congestive Heart Failure

Cited by 12 publications

References 8 publications

Nitroglycerin Ointment Effective for Seven Hours in Severe Angina Pectoris

Nitroglycerin Ointment Effective for Seven Hours in Severe Angina Pectoris

Sustained anti‐anginal action of glyceryl trinitrate cream.

Pharmacokinetics and Diuretic Effect of Furosemide after Single Intravenous, Oral Tablet, and Newly Developed Oral Disintegrating Film Administration in Healthy Beagle Dogs

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