IV NITROGLYCERIN -WHAT ARE THE ADVANTAGES? Effectiveness in controlling arrythmias: a case report A 51-year-old man was admitted'to hospital with severe retrosternal chest pressure. He was initially asymptomatic but after 72 hours developed spontaneous recurrent bouts of chest pain. These recurred every 5-6 hours and were quickly relieved with sublingual nitroglycerin (glyceryl trinitrate), As ventricular tachycardia developed with most episodes of chest pain, treatment was started with propranolol 120mg qid, isosorbide dinitrate sublingually every 3 hours and 2.5cm nitroglycerin paste every 4 hours. The patient was also given an infusion of lidocaine (lignocaine) Img/ min. He continued to complain of chest pain and the ECG showed distinct ST segment depression with ventricular ectopic activity. This failed to respond to O',3mgnitroglycerin given' sublingually so 100mg IV lidocaine was given. This shifted the ST segments to the baseline but the shift recurred, acoompanied by high-grade ventricular ectopic activity and tachycardia, I OOllg nitroglycerin was given IV and within 2 min the ECG had become normal. The patient made an uneventful recovery Antman, E. et al.: British Heart Journal 43: 88 (Jan 1980)

Relief of refractory angina; a study of 75 patients 45 patients with myocardial ischemia (group nand 30 patients with acute myocardial infarction (group II) were treated with nitroglycerin 5J.lg/min increased by 5-7 ug every few minutes until chest pain was relieved or BP fell by 20mm Hg. 28 patients in group I and 19 in group II had not obtained relief from chest pain with sublingual nitroglycerin. but IV therapy relieved the pain in 24 and 14 patients, respectively, in the 2 groups. This therapy did not reduce narcotic requirements in group II patients but there was a decrease in narcotic use in 20-29 patients in group I. 19 of the patients developed a headache during the infusion but this was relieved with aspirin or acetaminophen (paracetamol) in 17 patients and low-dose codeine in 2, Mikolich, J.R. et al.: Chest 77: 375 (Mar 1980)

Is it time for an IV preparation on the market 7 Nitroglycerin has been used to treat chest pain due to myocardial ischemia for more than 100 years, but neither the mechanism of its action nor the indications for its use are settled. Many patients in a study by Mikolich showed subjective improvement in chest pain with IV therapy that had failed to respond to sublingual nitroglycerin. The infusion was safe andinvasive hemodynamic monitoring was not required. IV infusion offers the advantage of better dosage control in unstable patients who may develop excessive hypotension or reflex tachycardia. More studies are needed. The risks and indications need to be defined but there is sufficient reason to hope that IV nitroglycerin will soon be marketed and approved for clinical use -. Loeb.H,S,: Chest 77: 374 (Mar 1980)

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INPHARMA 19 Apr 1980

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