COMPLICATIONS WITH Gl YCERYl TRINITRATE It seems to cause coronary artery narrowing Two patients developed unusual coronary angiographic responses after treatment with glyceryl trinitrate (nitroglycerin). Localised arterial narrowing occurred in the right coronary artery while the surrounding vessel and other coronary arteries dilated in the usual way. The responses could not be explained by spontaneous or catheter-induced spasm or haemodynamic changes and both patients remained asymptomatic. This was the first report of vasomotor changes producing discrete coronary arterial narrowing after sublingual glyceryl trinitrate. The patients, men aged 61 and 53 years, showed arterial narrowing for at least 20 minutes despite removal of the catheter and additional sublingual glyceryl trinitrate to a total dose of 1.2mg. Glyceryl trinitrate was not proved to cause the arterial narrowing, but lack of other reasonable explanations suggested it influenced the vasomotor responses. Feldman, R.L. et al.: American Journal of Cardiology 42: 517 (Sep 1978). Studies in 47 unpremedicated patients undergoing preoperative evaluation for chest pain showed that glyceryl trinitrate does alter the degree of coronary artery narrowing (an increase in 28 and a decrease in 3). Routine administration of glyceryl trinitrate before angiography would have added at least I more significant narrowing in 14 of the 47 study patients, thus altering interpretation of the angiogram. One patient developed a similar response to the 2 described above. Feldman, R.L. et a!.: British Heart Joumal40 : 992 (Sep 1978)) Arterial hypoxaemia after the sublingual form in patients with coronary artery disease Significant falls in Pa0 2 occurred in 21 patients with typical stable exertional angina after treatment with sublingual glyceryl trinitrate. 13 had been given morphine hyoscine.(scopolamine) pr.emedication and 8 were not premedicated. All were breathing room air. Premedication appeared to lower initial Pa0 2 values, but the fall in PaO] after glyceryl trinitrate was about the same with or without premedication. A!l2' patients received glyceryJ trinitrate in a dosage ofO.6mg and patients were assessed 10 minutes later. In the premedicated patients haemodynamic studies were performed in addition to biood gases (which were studied in all 21 patients) and showed reductions in arterial P0 2 , mean arterial pressure, cardiac index, central venous pressure, pulmonary artery pressure and pulmonary artery wedge pressure. High inspired oxygen concentrations seemed useful in 2 patients whose anginal pain persisted despite glyceryl trinitrate. Kopman, E.A. et a!.: American Heart Journal 96: 444 (Oct 1978) INPHARMA 23rd December, 1978 p7

COMPLICATIONS WITH GLYCERYL TRINITRATE

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COMPLICATIONS WITH Gl YCERYl TRINITRATE

It seems to cause coronary artery narrowing Two patients developed unusual coronary angiographic responses after treatment with glyceryl trinitrate (nitroglycerin). Localised arterial narrowing occurred in the right coronary artery while the surrounding vessel and other coronary arteries dilated in the usual way. The responses could not be explained by spontaneous or catheter-induced spasm or haemodynamic changes and both patients remained asymptomatic. This was the first report of vasomotor changes producing discrete coronary arterial narrowing after sublingual glyceryl trinitrate. The patients, men aged 61 and 53 years, showed arterial narrowing for at least 20 minutes despite removal of the catheter and additional sublingual glyceryl trinitrate to a total dose of 1.2mg. Glyceryl trinitrate was not proved to cause the arterial narrowing, but lack of other reasonable explanations suggested it influenced the vasomotor responses. Feldman, R.L. et al.: American Journal of Cardiology 42: 517 (Sep 1978).

Studies in 47 unpremedicated patients undergoing preoperative evaluation for chest pain showed that glyceryl trinitrate does alter the degree of coronary artery narrowing (an increase in 28 and a decrease in 3). Routine administration of glyceryl trinitrate before angiography would have added at least I more significant narrowing in 14 of the 47 study patients, thus altering interpretation of the angiogram. One patient developed a similar response to the 2 described above. Feldman, R.L. et a!.: British Heart Joumal40: 992 (Sep 1978))

Arterial hypoxaemia after the sublingual form in patients with coronary artery disease Significant falls in Pa02 occurred in 21 patients with typical stable exertional angina after treatment with sublingual glyceryl trinitrate. 13 had been given morphine hyoscine.(scopolamine) pr.emedication and 8 were not premedicated. All were breathing room air. Premedication appeared to lower initial Pa02 values, but the fall in PaO] after glyceryl trinitrate was about the same with or without premedication. A!l2' patients received glyceryJ trinitrate in a dosage ofO.6mg and patients were assessed 10 minutes later. In the premedicated patients haemodynamic studies were performed in addition to biood gases (which were studied in all 21 patients) and showed reductions in arterial P02, mean arterial pressure, cardiac index, central venous pressure, pulmonary artery pressure and pulmonary artery wedge pressure. High inspired oxygen concentrations seemed useful in 2 patients whose anginal pain persisted despite glyceryl trinitrate. Kopman, E.A. et a!.: American Heart Journal 96: 444 (Oct 1978)

INPHARMA 23rd December, 1978 p7