From the January 1994 issue of Medical Sciences Bulletin , published by Pharmaceutical Information Associates, Ltd.
Nitric oxide is a smooth-
muscle relaxant with general effects on
vascular,
bronchial, and
biliary smooth muscle. Recently Hassel described the use of a nitric oxide donor --
nitroglycerin -- in three patients with
biliary colic. All three patients had
ultrasonography-confirmed
gallbladder stones, and all three had severe
biliary colic that showed a striking response to
nitroglycerin. The first patient, a 25-year-old woman, experienced
acute, severe pain in the right
hypochondrium, radiating to the right
scapula and accompanied by
vomiting and
restlessness.
Palpation caused a sharp
pain that was worse on deep
inspiration (
Murphy's sign). A
sublingual nitroglycerin tablet (0.5 mg) relieved the
pain within 20 seconds. When the
pain returned 2 hours later, a 20Êmg
oral isosorbide dinitrate tablet kept the patient free of
pain for at least 12 hours.
The second patient was a 46-year-old man who had
acute,
severe pain in the right
hypochondrium radiating to the
back and accompanied by
nausea and
restlessness.
Palpation caused the characteristic
pain;
Murphy's sign was present.
Nitroglycerin 0.4 mg
sublingually (via spray) relieved the
pain within 30 seconds. The
pain gradually recurred after 20 minutes. Another dose of
nitroglycerin reduced the
pain to a weak
ache. The third patient, a 70-year-old man, had frequent attacks of
biliary colic that appeared within 15 minutes of a
meal and lasted 4 to 6 hours. He had a positive
cholecystogram and had undergone
papillotomy, but stones remained in the
gallbladder.
Colecystectomywas
contraindicated because the patient had
severe bronchial asthma and
obesity.
Pain responded moderately to oral
opioids. A
sublingual 0.5 mg
nitroglycerin tablet relieved the
pain completely within 60 seconds, and the effect lasted for at least 12 hours.
In these patients,
NG proved to be an effective and rapidly acting agent for
biliary colic, relaxing biliary smooth muscle and reducing
spasms. Hassel concluded, "
Nitroglycerin may be a useful alternative to
analgesic treatment in the acute situation and in the
inoperable patient."
A patient's perspective:
I am 24, and to have been prescribed nitroglycerin came as a shock. it's for old people. For people having heart attacks. I suffered through several attacks before I finally decided to give it a try when I suffered an attack at work. One dose reduced the pain, and five minutes after the first, a second dose eliminated the pain entirely.
What does this mean for me? I don't know. I usually have attacks only at night, and I am in so much pain and and so groggy and confused that I am unlikely take any action other than curling into a ball. The nitroglycerin makes me feel a bit hyper and very hot, and so I doubt my ability to get back to sleep after taking a dose (and one of my primary concerns is the continual lack of sleep caused by the attacks).
I don't know how much I am like the test cases. MRCP, MRI, and sonogram show no stone or stricture in the bile duct (and thus the doc says he assumes spasm of the sphinter or sludge in the common bile duct). I was prescribed nitroglycerin to see if it helped attacks until I could have an ERCP procedure done. It works well on daytime attacks, but at night I am not aware enough of my surroundings to actually take it. Overall, though, I would recommend that anyone suffering acute attacks of biliary colic ask their doctor about nitroglycerin, the effects are immediate.