Key result
Sublingual and aerosol nitroglycerin show equivalent hemodynamics, while IV yields fastest LVEDP reduction.
Why the study?
The plasma concentrations and hemodynamic effects of intravenous, sublingual, and aerosolized nitroglycerin in patients undergoing cardiac catheterization were not fully characterized.
Does the route of administration of nitroglycerin affect plasma concentrations and hemodynamics in patients with coronary artery disease undergoing cardiac catheterization?
Does the route of administration of nitroglycerin affect plasma concentrations and hemodynamics in patients with coronary artery disease undergoing cardiac catheterization?
Sublingual and aerosolized nitroglycerin provide equivalent hemodynamic efficacy in patients undergoing cardiac catheterization, though intravenous administration reduces LVEDP most rapidly.
Answers are grounded in this paper and cite their sources.
Aerosolized nitroglycerin matches sublingual hemodynamic effects in catheterization; leaves open broader acute-use comparisons.
Intravenous, sublingual, or aerosolized nitroglycerin was administered to 19 patients with coronary artery disease during clinically indicated cardiac catheterization. Eight blood samples were collected over 15 min from each patient, and analyzed for content of nitroglycerin, 1,2-glycerol dinitrate, and 1,3-glycerol dinitrate. Simultaneously, heart rate (HR), systolic blood pressure (SBP), and left ventricular end-diastolic pressure (LVEDP) were recorded. Plasma concentrations of nitroglycerin were highest after intravenous injection and lowest after sublingual tablets. Metabolite concentrations were highest after intravenous injection at early time-points; at later time-points, no between-group differences could be detected. SBP was minimally affected by intravenous nitroglycerin but was significantly reduced by sublingual and aerosolized formulations. Minor fluctuations in HR were observed in association with all three formulations. LVEDP was reduced by all three formulations of nitroglycerin but most rapidly by the intravenous form. Overall, no differences were detected in hemodynamic responses caused by sublingual and aerosolized nitroglycerin. Efficacy of sublingual and aerosolized nitroglycerin in patients undergoing cardiac catheterization is equivalent.
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Curry et al. (1993) studied Coronary artery disease (n=19). Intravenous, sublingual, or aerosolized nitroglycerin vs. Comparison between the three formulations was evaluated on Plasma concentrations of nitroglycerin and metabolites, and hemodynamic responses (HR, SBP, LVEDP). Sublingual and aerosolized nitroglycerin demonstrated equivalent hemodynamic efficacy, while intravenous administration produced the highest plasma concentrations and most rapid LVEDP reduction.
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