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Title: Combined use of nitroglycerin and N-acetylcysteine in the management of unstable angina pectoris.
Austin Authors: Horowitz, J D;Henry, C A;Syrjanen, M L;Louis, William J ;Fish, R D;Smith, T W;Antman, E M
Affiliation: Department of Cardiology, Austin Hospital, Heidelberg, Victoria, Australia
Issue Date: 1-Apr-1988
Publication information: Circulation; 77(4): 787-94
Abstract: The vasodilator effects of nitroglycerin (NTG) are mediated via activation of guanylate cyclase; this process is believed to require the availability of free sulfhydryl groups. Previous studies in man have shown that the sulfhydryl donor N-acetylcysteine (NAC) potentiates the systemic and coronary vasodilator effects of NTG. Furthermore, interaction of NTG and NAC may lead to the formation of S-nitroso-NAC, which strongly inhibits platelet aggregation. The effects of intravenous NTG combined with intravenous NAC (5 g 6 hourly) were compared with those of intravenous NTG alone in a double-blind trial in 46 patients with severe unstable angina pectoris unresponsive to conventional treatment, which included calcium antagonists and cutaneous nitrates in all but one patient. Treatment with NTG/NAC (24 patients) and that with NTG alone (22 patients) was associated with a similar frequency of episodes of chest pain and of increments in NTG infusion rate for pain control (10 vs 17; p = NS). The NTG/NAC group had a significantly lower incidence of acute myocardial infarction than the NTG/placebo group (three vs 10 patients; p = .013). Symptomatic hypotension occurred frequently in the NTG/NAC group (seven vs 0 patients; p = .006). Lactate-pyruvate ratios and venous NTG concentrations were not significantly affected by NAC. Subsequently, another 20 consecutive patients were treated with intravenous NTG and continuously infused NAC (10 g/day). Seven remained pain free during the first 24 hr of NTG infusion; 11 required increments in NTG infusion rate for pain control. Acute myocardial infarction occurred in one patient, while none developed symptomatic hypotension.(ABSTRACT TRUNCATED AT 250 WORDS)
Gov't Doc #: 3127076
Journal: Circulation
Type: Journal Article
Subjects: Acetylcysteine.administration & dosage.adverse effects.therapeutic use
Angina Pectoris.drug therapy
Angina, Unstable.drug therapy
Clinical Trials as Topic
Double-Blind Method
Drug Therapy, Combination
Hypotension.chemically induced
Myocardial Infarction.prevention & control
Nitroglycerin.administration & dosage.therapeutic use
Random Allocation
Risk Factors
Appears in Collections:Journal articles

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