Side Effects of nitroglycerin topical: A Synthesis of Findings from 28 Studies

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Original Abstract of the Article

Key Research Findings

Topical nitroglycerin is a common treatment for anal fissures and has gained popularity in the West. 17 Several studies have shown that topical nitroglycerin can effectively reduce pain and promote healing in patients with anal fissures. 12 , 18 This drug has also been used successfully in treating lateral epicondylitis, also known as tennis elbow, by reducing pain and improving function. 2 Furthermore, research suggests that topical nitroglycerin can help prevent skin flap necrosis after mastectomy. 4

Reasons for Side Effects

The vasodilating properties of topical nitroglycerin can cause several side effects, including headaches and facial flushing. 20 Furthermore, nitroglycerin is easily absorbed through the skin, which can lead to skin irritation.

Common Side Effects

Headache

Headache is the most common side effect reported in numerous studies involving topical nitroglycerin. 20 , 23 This effect is often attributed to the vasodilating properties of nitroglycerin.

Facial Flushing

Facial flushing is another common side effect associated with topical nitroglycerin use. 20 Similar to headaches, this is likely due to the vasodilating properties of the medication.

Dizziness

Some patients have reported experiencing dizziness while using topical nitroglycerin. 20 This side effect might be related to the blood pressure-lowering effect of the medication.

Hypotension

Topical nitroglycerin can lower blood pressure, which is a potential side effect. 20 This is primarily attributed to the vasodilating effect of the medication.

Skin Irritation

Skin irritation can occur as a side effect of topical nitroglycerin use. 20 This is due to the easy absorption of nitroglycerin through the skin, which can cause irritation.

Measures to Address Side Effects

Headache

If you experience headaches while using topical nitroglycerin, consulting a doctor is recommended. They may prescribe medication to help alleviate the headaches.

Facial Flushing

Facial flushing usually subsides after discontinuing the use of topical nitroglycerin. However, if you are concerned about this side effect, consult a doctor for advice.

Dizziness

If you experience dizziness while using topical nitroglycerin, consulting a doctor is advised. They may prescribe medication to alleviate the dizziness.

Hypotension

If you experience hypotension while using topical nitroglycerin, consulting a doctor is recommended. They may prescribe medication to help manage the hypotension.

Skin Irritation

If you experience skin irritation while using topical nitroglycerin, consulting a doctor is advisable. They may prescribe medication to help alleviate the skin irritation.

Comparison Between Studies

Similarities

Multiple studies have investigated the use of topical nitroglycerin for various conditions, including anal fissures, lateral epicondylitis, and skin flap necrosis. These studies consistently demonstrate the effectiveness of topical nitroglycerin in reducing pain and promoting healing. Furthermore, a common finding across many studies is the occurrence of side effects such as headache, facial flushing, and hypotension.

Differences

The effectiveness and side effects of topical nitroglycerin can vary depending on the specific condition being treated and the individual patient. For example, topical nitroglycerin appears to be highly effective in treating anal fissures compared to other treatment methods. 17 However, the effectiveness in treating skin flap necrosis after mastectomy may be limited. 4 Additionally, the severity of side effects can vary greatly among individuals.

Points to Note Regarding Application in Real Life

It is crucial to use topical nitroglycerin as directed by a healthcare professional. Self-treating with this medication can increase the risk of experiencing side effects. Be mindful of potential side effects such as headaches, facial flushing, dizziness, and hypotension. If you encounter any of these side effects, promptly consult a doctor.

Limitations of Current Research

The research on topical nitroglycerin is still ongoing, and further studies are necessary to fully understand its long-term safety and efficacy. More research is also needed to develop strategies for effectively minimizing the side effects associated with this medication.

Directions for Future Research

Future research should focus on evaluating the long-term safety and efficacy of topical nitroglycerin. Developing methods to effectively reduce the side effects of topical nitroglycerin is also crucial for improving patient outcomes.

Conclusion

Topical nitroglycerin is a valuable treatment option for various conditions, including anal fissures, lateral epicondylitis, and skin flap necrosis. However, it is important to be aware of the potential side effects, including headache, facial flushing, hypotension, and skin irritation. Always consult a healthcare professional before using topical nitroglycerin and follow their instructions carefully.

Literature analysis of 28 papers
Positive Content
25
Neutral Content
2
Negative Content
1
Article Type
13
1
2
2
28
1.

Topical Nitroglycerin Ointment Reduces Mastectomy Flap Necrosis in Immediate Autologous Breast Reconstruction.

Author: YaoAmy, GreigeNicolas, RicciJoseph A, DraperLawrence B, WeichmanKatie E

MFN prevention

Mastectomy flap necrosis (MFN) is a serious complication of breast reconstruction. This article examines the potential benefits of topical nitroglycerin ointment for preventing MFN in immediate autologous breast reconstruction.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

2.

Management of Lateral Epicondylitis Using Transdermal Nitroglycerin: A Systematic Review.

Author: McCullochCara, HunterMiles M, LippChris, LangEddy, GanshornHeather, SinghPavneet

LE function improvement
LE pain relief
Dermatitis
Headaches

This systematic review assessed the current literature on the effect of transdermal nitroglycerin (NTG) patches for the treatment of lateral epicondylitis (LE). The studies reviewed showed improvement in elbow pain and function in the short- and mid-term, highlighting the potential benefit of NTG patches for LE treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

3.

Neonatal ischemic limb lesions: From etiology to topical nitroglycerine. A case series analysis.

Author: FalsaperlaRaffaele, Lo BiancoManuela, GiugnoAndrea, LenaGermana, SciutoLaura, SpataFrancesco, GuarneriClaudio, PavonePiero, RuggieriMartino

Ischemic lesion treatment
Cardiac arrest

Three preterm neonates experienced ischemic lesions following cardiac arrest and radial blood sampling, highlighting this as an underestimated cause. While treatment with nitroglycerine ointment showed positive results, further studies are needed to establish a defined protocol.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

4.

Efficacy and safety of topical nitroglycerin in the prevention of mastectomy flap necrosis: a systematic review and meta-analysis.

Author: WangPu, GuLuosha, QinZelian, WangQifei, MaJianxun

Flap necrosis prevention

Nitroglycerin (NTG) ointment significantly reduced the rates of mastectomy flap necrosis and other complications. There was no significant difference in drug-related adverse reactions.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

5.

Use of nitroglycerin ointment to treat primary and secondary Raynaud's phenomenon: a systematic literature review.

Author: QiuOlivia, ChanTheresa, LuenMatthew, CruzJoseph E, Hermes-DeSantisEvelyn R

RP treatment

Nitroglycerin ointment, a topical nitrate, shows promise for treating Raynaud's phenomenon (RP) and offers a convenient as-needed option for managing unpredictable ischemic attacks. More robust studies are needed to fully understand its efficacy and safety.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

7.

Efficacy of nitroglycerine ointment in the treatment of pediatric anal fissure.

Author: JodaAli E, Al-MayoofAli F

This study investigates the safety and efficacy of nitroglycerine (NTG) ointment in treating pediatric anal fissure, a common condition in children. The study aims to provide evidence for the effectiveness of NTG ointment as a conservative treatment option, potentially reducing the need for invasive procedures.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

9.

Internal sphincterotomy versus topical nitroglycerin ointment for chronic anal fissure.

Author: AslamMuhammad I, PervaizArif, FigueiredoRodrigo

Anal fissure treatment
Incontinence

Chronic anal fissure, a common condition, is characterized by a split in the anal canal mucosa persisting for more than two months. While surgical treatment carries risks of complications, chemical sphincterotomy is currently favored due to its potential for improved outcomes.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

10.

Glyceryl trinitrate ointment did not reduce pain after stapled hemorrhoidectomy: a randomized controlled trial.

Author: CrossTrent, BartlettLynne, MushayaChrispen, AshourMohamed, HoYik-Hong

Increased pain
Side effects

This study compared the effects of topical glyceryl trinitrate (GTN) with routine postoperative management after stapled hemorrhoidopexy. GTN did not reduce postoperative pain and was associated with more side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

11.

A prospective, randomized, double-blind study comparing the efficacy of diltiazem, glyceryl trinitrate, and lidocaine for the treatment of anal fissure in children.

Author: CevikMuazez, BolekenMehmet Emin, KorukIbrahim, OcalServet, BalciogluMehmet Emin, AydinogluAsim, KaradagCetin Ali

Effective treatment
Low recurrence
Minimal side effects

Diltiazem ointment was effective and safe for the treatment of anal fissure (AF) in children, with a significantly higher healing rate and lower recurrence rate than other treatments. Diltiazem had minimal side effects due to its smooth dose-concentration curve.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

12.

Optimal treatment duration of glyceryl trinitrate for chronic anal fissure: results of a prospective randomized multicenter trial.

Author: GagliardiG, PascarielloA, AltomareD F, ArcanàF, CafaroD, La TorreF, De NardiP, BassoL, De StefanoI, GrecoV J, VasapolloL, AmatoA, Pulvirenti D'UrsoA, AielloD, BoveA

Fissure healing
Pain relief
Side effects

Topical glyceryl trinitrate treatment for 40 days was as effective as treatment for 80 days in healing chronic anal fissures and reducing pain. Both treatments showed significant improvement in pain and healing until 40 days, but further benefits were not observed after that.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

13.

[Local treatment of a chronic anal fissure with diltiazem vs. nitroglycerin. A comparative study].

Author: PucheJosé J, García-CoretM José, VillalbaFrancisco L, Ali-MahmoudIsmail, RoigJosé V

Avoid surgery
More symptomatic relief
Recurrence
Side effects (nitroglycerin)

Smooth muscle relaxant drugs, like diltiazem and nitroglycerin, offered more symptomatic relief than traditional measures for chronic anal fissure (CAF) but did not achieve a higher cure rate. Topical diltiazem was better tolerated than nitroglycerin.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Spanish

15.

Topical diltiazem hydrochloride and glyceryl trinitrate in the treatment of chronic anal fissure.

Author: JawaidMasood, MasoodZubia, SalimManzar

Anal fissure treatment
Headache

Topical diltiazem hydrochloride and glyceryl trinitrate were equally effective in healing chronic anal fissure. Diltiazem caused fewer side effects, particularly headaches, than glyceryl trinitrate ointment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

16.

MQX-503, a novel formulation of nitroglycerin, improves the severity of Raynaud's phenomenon: a randomized, controlled trial.

Author: ChungLorinda, ShapiroLee, FiorentinoDavid, BaronMurray, ShanahanJoseph, SuleSangeeta, HsuVivien, RothfieldNaomi, SteenVirginia, MartinRichard W, SmithEdwin, MayesMaureen, SimmsRobert, PopeJanet, KahalehBashar, CsukaM E, GruberBarry, CollierDavid, SweissNadera, GilbertAdam, DechowFrederick J, GregoryJeffrey, WigleyFredrick M

RP treatment
Dizziness
Headache
Skin irritation

Raynaud's phenomenon (RP) affects 3-9% of the general population and >90% of patients with systemic sclerosis. Nitrates are often prescribed for RP treatment, but current formulations are limited by side effects such as headaches, dizziness, and skin irritation. This study aimed to evaluate the tolerability and efficacy of a novel topical nitroglycerin formulation, MQX-503, in treating RP in an ambulatory setting.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

17.

Comparison of topical glyceryl trinitrate with lignocaine ointment for treatment of anal fissure: a randomised controlled trial.

Author: AhmadJ, AndrabiS I H, RathoreM A

Anal fissure treatment
Side effects

This study compared the efficacy of topical glyceryl trinitrate (GTN) with lignocaine for the treatment of anal fissures in a South Asian population. The results will be used to determine the best treatment option for this specific population.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

18.

A comparison of the effects of diltiazem and glyceryl trinitrate ointment in the treatment of chronic anal fissure: a randomized clinical trial.

Author: ShrivastavaU K, JainB K, KumarPraveen, SaifeeYusuf

Anal fissure treatment
Anal incontinence

This study discusses the treatment of chronic anal fissure, a common problem affecting all age groups. Traditional surgical treatments, like manual anal dilatation or sphincterotomy, can be effective but carry a risk of incontinence. The study highlights the growing use of medical therapies for chronic anal fissure, which offer an alternative approach without the risk of incontinence.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

19.

[Effectiveness of contemporary injection of botulinum toxin and topical application of glyceryl trinitrate against postoperative pain after Milligan-Morgan haemorrhoidectomy].

Author: PattiRosalia, AngileriMariangela, MiglioreGiovanni, SammartanoSergio, TermineStefania, CrivelloFloriana, GioèFranco Paolo, Di VitaGaetano

haemorrhoidectomy pain relief

This study evaluated the effectiveness and safety of a combination therapy using botulinum toxin (Tox) and glyceryl trinitrate (GT) after Milligan-Morgan haemorrhoidectomy. The therapy aimed to reduce the maximum resting pressure (MRP) of the anal canal, which contributes to postoperative pain.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Italian

20.

Allergic and nonallergic reactions to nitroglycerin.

Author: RameyJohn T, LockeyRichard F

Oral nitroglycerin tolerated
Allergic contact dermatitis
Facial flushing
Fainting
Head throbbing
Headache
Hypotension
Irritant contact dermatitis
Syncope
Tachycardia
Urticaria

Nitroglycerin can cause allergic and nonallergic reactions. The most common side effects include headache, flushing, throbbing, fainting, hypotension, tachycardia, and syncope. Skin reactions to topical nitroglycerin are usually irritant or allergic contact dermatitis, or urticaria. Although rare, oral, sublingual, intravenous, or perianal nitroglycerin products can also trigger allergic reactions. Patch testing can help identify allergic contact dermatitis to topical nitroglycerin. Avoiding topical nitroglycerin products and considering oral or sublingual alternatives may be necessary for patients with positive patch tests.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

21.

Efficacy and safety of botulinum toxin a injection compared with topical nitroglycerin ointment for the treatment of chronic anal fissure: a prospective randomized study.

Author: FruehaufHeiko, FriedMichael, WegmuellerBarbara, BauerfeindPeter, ThumshirnMiriam

Healing of CAF
Mild side effects

Topical nitroglycerin ointment was more effective than botulinum toxin A injection for the initial healing of chronic anal fissure (CAF), but was associated with more, but milder side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

22.

Controlled dose delivery in topical treatment of anal fissure: pilot study of a new paradigm.

Author: TorrabadellaLuis, SalgadoGervasio

Anal fissure treatment
Side effects

This study compared the efficacy and side effects of conventional topical nitroglycerin application with precise intra-anal dosing of nitroglycerin in patients with anal fissure.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

23.

[Efficacy of topical use of 0.2% glyceryl trinitrate in reducing post-haemorrhoidectomy pain and improving wound healing].

Author: PattiRosalia, ArcaraMatteo, PadronaggioDomenico, BonventreSebastiano, AngileriMariangela, SalernoRosaria, RomanoPietro, BuscemiSalvatore, Di VitaGaetano

Reduced healing time
Reduced pain
Headache

Topical glyceryl trinitrate ointment was effective in reducing post-haemorrhoidectomy pain and healing time, but a significant number of patients experienced headaches.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Italian

24.

The use of glyceryl trinitrate (GTN) in the treatment of chronic anal fissure in children.

Author: SimpsonJohn, LundJonathan N, ThompsonRichard J, KapilaLeela, ScholefieldJohn H

Chronic anal fissure treatment
Headaches

Glyceryl trinitrate (GTN) ointment is effective for anal fissures in adults, but headaches are common. This study investigates the safety and efficacy of lower-concentration GTN ointments in children with anal fissures.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

25.

The dose response of the internal anal sphincter to topical application of glyceryl trinitrate ointment.

Author: CundallJ D, GunnJ, EasterbrookJ R, TilsedJ V, DuthieG S

Anal sphincter relaxation
Dose related response
Headache

Glyceryl trinitrate (GTN) ointment causes a dose-related relaxation of the internal anal sphincter. Higher doses can be used without an increase in side-effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Controlled Clinical TrialA clinical trial that evaluates the effectiveness of a treatment by comparing a group that receives the intervention with a group that receives a placebo or standard treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

26.

A prospective randomized trial of diltiazem and glyceryltrinitrate ointment in the treatment of chronic anal fissure.

Author: BieleckiK, KolodziejczakM

Anal fissure healing
Fewer side effects
Dizziness
Headache

Diltiazem and glyceryltrinitrate (GTN) were equally effective in healing anal fissures. However, diltiazem was associated with fewer side effects compared to GTN.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

27.

Efficacy of topical nitroglycerin and transcutaneous electrical nerve stimulation on survival of random-pattern skin flaps in rats.

Author: AtalayCan, KoçkayaE Arzu, CetinBahadir, KismetKemal, AkayM Turan

Skin flap survival

The efficacy of topical nitroglycerin and transcutaneous electrical nerve stimulation (TENS) on the survival of random-pattern skin flaps in rats was compared. TENS was found to be significantly more effective than nitroglycerin in promoting flap survival.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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