Treatment of Suspected Cholelithiasis With Nitroglycerin
Status:
Unknown status
Trial end date:
2019-03-01
Target enrollment:
Participant gender:
Summary
ABSTRACT: Sublingual nitroglycerin has been advocated for the treatment of acute pain from
suspected symptomatic cholelithiasis. There is, however, no clinical studies that validate
its use. This study is designed to evaluate the efficacy of nitroglycerine in relieving acute
pain of suspected biliary tract origin.
Nitroglycerin is a potent smooth muscle relaxant used for biliary tract dilation during ERCP,
(Chelly, J) and has been recommended for treatment of biliary colic based on anecdotal
experience and small case reports. Nitroglycerin effect is a result of the nitric oxide
component of the medication which acts as a smooth muscle relaxant in vascular, bronchial,
esophageal and biliary smooth muscles. [McGowan(1936), Chelly (1979),Toyoyama (2001)] The
typical dose of nitroglycerin is 0.4 mg given sublingually in pill form or, more recently, in
a metered spray form. In a case series reported by Hassel (1993), positive response times
ranged from 20 to 60 seconds with duration of action of two to twelve hours. Sublingual
nitroglycerin is most commonly used for treatment of chest pain related to insufficient
cardiac perfusion. It has also been noted to relieve the pain of esophageal spasms.
Nitroglycerin has an excellent safety profile if used in patients with adequate pretreatment
blood pressures. [Newberry (2005), Nitroglycerine (2011), Nitro (2011), Wolters (2009)] This
study proposes to compare sublingual 0.4 mg doses of nitroglycerin to placebo for the initial
treatment of acute pain from suspected symptomatic cholelithiasis