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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nitroglycerin was administered to eight healthy volunteers in the form of sublingual tablets, oral sustained-release tablets, and an oral solution. Blood samples were collected for measurement of nitroglycerin and its two isomeric glyceryl dinitrate metabolites. Blood pressure and pulse rate were monitored; subjective evaluations of headache, dizziness, facial flushing, skin irritation, and gastrointestinal upset were made. Nitroglycerin itself was virtually undetectable after the solution and tablet preparations; the metabolites were consistently detectable from a few minutes after dosing to 24 h later. Mean total (nitroglycerin plus metabolite) concentrations were comparable in the 15 min following sublingual administration, and the 8 h following tablet administration. The relative bioavailability of the tablets in comparison with the oral solution was 70 per cent based on metabolite concentrations. Nitroglycerin sustained-release tablets appear to exert their beneficial effects in the prolonged prophylaxis of angina through active metabolites.
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PMID:Pharmacokinetics of nitroglycerin and its metabolites after administration of sustained-release tablets. 155 Sep 9

The hemodynamics influencing effect of Nitromint sublingual tablet and aerosol (EGIS Pharmaceuticals) has been examined in 22 ischaemic heart disease patients during heart catheterisation. The patients were hospitalized and took also the earlier prescribed drugs. On the basis of the results of examinations it may be concluded that Nitromint aerosol has a therapeutic action comparable to other short-acting nitrate preparations such as sublingual nitroglycerin tablet. According to the observations of the patients the drug action develops within a significantly shorter period. Considering the type of side-effects there was no difference between the two drug forms. Primarily, Nitromint tablet caused systemic effects (headache, dizziness, throbbing head) while aerosol caused predominantly local symptoms (burning of the tongue, disagreeable taste). These effects were only temporary and ceased within 10 minutes. According to the above described observations Nitromint aerosol may successfully be used as a new nitroglycerin containing drug form in all forms of angina pectoris: in rest angina, effort angina, as a prophylaxis, in mixed type angina pectoris, as a first-aid in emergency cases in acute left heart failure, preceding the application of infusion.
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PMID:Comparative haemodynamic examination of Nitromint (sublingual tablet and aerosol). 158 77

There are many theories and hypotheses concerning with the pathogenesis of migraine. The clinical effectiveness of vasoactive drugs and many investigations on the cerebral blood flow in patients with migraine strongly support a vascular theory. In present paper we report a case of 26-year-old Japanese male, who suffered from hemiplegic migraine and coincidental coronary vasospasm, and discussed the pathogenesis of migraine. In October 1986, the patient developed the first attack of throbbing headache in the left temporal area with nausea and vomiting, following typical visual aura. One week later, he developed the second migrainous attack and then he felt his right extremities paralyzed and numb. Although the headache and weakness resolved within one hour, similar migrainous attack with transient hemiparesis repeated two or three times a month. Although the longest period required for resolving weakness was three days, the MRI, the CT and the electroencephalogram revealed no significant abnormality. In January 1987, during his stereotyped attack of hemiplegic migraine, he also developed oppressive feeling on his anterior chest and these symptoms resolved within fifteen minutes. Because the results of Holter electrocardiogram and ultrasound echocardiogram indicated angina pectoris, a coronary angiography was performed in February 1987. During the angiographical procedures, he began to complain of the oppressive feeling on his anterior chest, and the coronary angiography revealed the definite vasospasm in the anterior descending branch of the left coronary artery. Sublingual nitroglycerin administration resolved the vasospasm, but thereafter the patient developed his stereotyped hemiplegic migrainous attack.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hemiplegic migraine complicated with coronary vasospasm]. 162 39

1. Nitrates have a place in the prophylactic treatment of patients with angina pectoris. Their efficacy is not in doubt. 2. However, there may be some practical problems associated with their use, such as unreliable absorption, short duration of action, treatment-induced headache, development of nitrate tolerance and a suggested rebound phenomenon observed during intermittent dosing. Furthermore, patient convenience with treatment schedule and patient compliance have to be considered during prophylactic treatment. The present article discusses how many of these problems may be solved by selection of formulation as well as nitrate compound. 3. The development of controlled-release formulations producing sufficiently high nitrate plasma concentration during part of the day followed by nitrate-poor rather than nitrate-free interval, have the potential to prevent both nitrate tolerance and rebound phenomenon, and produce a sufficiently long duration of action with a convenient once daily regimen.
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PMID:Prophylactic nitrate therapy in angina pectoris--is there an optimal treatment regimen? 163 74

Celiprolol is a third generation beta blocking drug with intrinsic vasodilator effect. We evaluated the effect of this drug at a fixed dose of 400 mg daily in 20 patients with coronary artery disease and stable angina having 2 to 40 episodes of pain a week. All patients had positive exercise stress test with greater than 1 mm ST depression. Compared to the 1 month baseline placebo phase, patients after 3 months of treatment with celiprolol had less episodes of angina (2.4 vs 7.2 a week, p less than 0.001), higher angina threshold (667 vs 337 sec, p less than 0.025), higher ischemia threshold (614 vs 401 sec, p less than 0.001) and were able to perform more work (3937 vs 2403 kgm/min. p less than 0.01). 9 patients had no pain during exercise. A decrease in blood pressure, heart rate and double product was evident in the stress tests of the active phase. Adverse effects included headache (4 patients), sweating (1) and fatigue (1) not requiring modification of drug dose. No adverse effects were seen in 13 patients. Thus, celiprolol is effective to decrease angina during daily life and increase exercise tolerance in patients with chronic stable angina pectoris.
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PMID:[Celiprolol in the treatment of chronic stable angina]. 168 95

Hypertensive patients, particularly the elderly, may often suffer from other diseases. Therefore, antihypertensive compounds should not negatively affect such disorders. Felodipine is a calcium antagonist that has potentially beneficial effects in angina pectoris and congestive heart failure. Further, it does not adversely affect lung function in asthmatic patients or glucose tolerance in patients with diabetes. Preliminary investigations also indicate that felodipine has no negative influence on plasma lipid levels. Although felodipine seems to be safe in most patients, treatment with felodipine should at present be avoided in pregnant women, since digital anomalies have been observed in rabbit fetuses. The adverse effects seen during treatment with felodipine are usually mild and transient and generally related to the vasodilatory action of the drug, the most common being ankle edema, headache, flushing, dizziness, and palpitations. The only significant drug interactions with felodipine occur with inducers and inhibitors of the cytochrome P-450 system, which is responsible for the metabolism of felodipine.
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PMID:The safety of felodipine. 169 36

Nifedipine antagonises influx of calcium through cell membrane slow channels, and sustained release formulations of the calcium channel blocker have been shown to be effective in the treatment of mild to moderate hypertension and both stable and variant angina pectoris. Preliminary findings also indicate that these formulations are effective in the treatment of Raynaud's phenomenon and hypertension in pregnancy, and that they reduce the frequency of ischaemic episodes in some patients with silent myocardial ischaemia. The exact mechanism of action of nifedipine in all of these disorders has not been defined. However, its potent peripheral and coronary arterial dilator properties, together with improvements in oxygen supply/demand, are of particular importance. A major goal of sustained release therapy is to permit reductions in the frequency of nifedipine administration, preferably to once daily, and thus improve patient compliance. Two new once-daily formulations--the nifedipine gastrointestinal therapeutic system (GITS) and a fixed combination capsule comprising sustained release nifedipine 20 mg and atenolol 50 mg--have exhibited marked antihypertensive efficacy. The GITS preparation has also been used effectively in the treatment of stable angina pectoris, and both formulations appear to be well tolerated. Sustained release nifedipine formulations are generally better tolerated than their conventionally formulated counterparts, particularly with regard to reflex tachycardia. Adverse effects seem to be dose related, are mainly associated with the drug's potent vasodilatory action, and include headache, flushing and dizziness. Generally, these effects are mild to moderate in severity and transient, usually diminishing with continued treatment. Thus, sustained release nifedipine formulations are useful and established cardiovascular therapeutic agents which have demonstrable efficacy in various forms of angina, mild to moderate hypertension and Raynaud's phenomenon. Further, promising results shown by the nifedipine GITS formulation, with its advantage of once daily administration suggest that it is likely to become one of the preferred nifedipine formulations for the treatment of hypertension and the various forms of angina.
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PMID:Sustained release nifedipine formulations. An appraisal of their current uses and prospective roles in the treatment of hypertension, ischaemic heart disease and peripheral vascular disorders. 171 8

The antianginal effect and tolerability of isosorbide mononitrate (ISMN), 20 mg 2-3 times daily, orally were investigated in an open study in 28 patients, suffering from coronary heart disease and stable angina pectoris. Ergometric exercise tests were carried out before treatment and 2 h after drug intake, every 3 months during the first year and at 6-month intervals during the following 2 years. At the conclusion of the 3-year study the reduction of ST-segment depression, which had amounted to 58% after 1 year, could be improved to 78% (p less than 0.01). The frequency of angina was markedly reduced during the treatment with ISMN. While 14 of the patients had more than 3 episodes per day prior to the study, 16 patients were symptom-free at the end of the three years' therapy, and none of the patients had more than 1 or 2 attacks per day. The consumption of sublingual nitroglycerin diminished by 94% after one year and by 98% after 3 years of therapy (p less than 0.01). Headache was the only adverse effect observed in some of the patients (at the initiation of the treatment only). In conclusion this study demonstrated (1) the good tolerability of ISMN, at the doses used, and (2) the fact that the antianginal efficacy may be enhanced during the course of the therapy.
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PMID:Evaluation of effectiveness and tolerability of isosorbide mononitrate during a three-year period in patients with angina pectoris. 176 Aug 29

Felodipine, a dihydropyridine calcium-channel antagonist, significantly reduces systolic and diastolic blood pressure (BP) in patients with hypertension and has been associated with beneficial hemodynamic effects in patients with chronic stable angina pectoris or congestive heart failure (CHF). In hypertensive patients, felodipine does not appear to significantly affect glomerular filtration rate, creatinine clearance, glucose tolerance, or plasma lipoprotein concentrations. Studies comparing felodipine with other agents as monotherapy in mild to moderate hypertension have demonstrated felodipine to be at least as efficacious as hydrochlorothiazide (HCTZ) and HCTZ plus amiloride hydrochloride in combination. Comparisons of felodipine with other agents as adjuncts to beta-blocker or diuretic therapy have shown felodipine to be at least as effective as HCTZ, propranolol hydrochloride, prazosin hydrochloride, and nifedipine. Evaluations of patients with chronic stable angina are limited, and additional studies are needed before felodipine can be recommended for the routine management of angina pectoris. Similarly, additional studies are essential to delineate the role of felodipine, if any, in the management of CHF. In the management of hypertension, felodipine 5-40 mg/d significantly reduces systolic and diastolic BP. Although some patients may be controlled throughout the entire dosing interval when felodipine is administered bid, many patients will require more frequent dosing to obtain adequate BP control. Adverse effects associated with felodipine are similar to those of other dihydropyridine calcium-channel antagonists and include peripheral edema, headache, dizziness, flushing, and fatigue. A potentially clinically important drug interaction was observed when felodipine was administered concomitantly with theophylline aminopropanol; significant decreases in theophylline concentrations were noted. In summary, felodipine appears to be safe and effective for the management of hypertension when used alone or in combination with other antihypertensive agents. The efficacy of felodipine in the management of chronic stable angina pectoris and CHF requires further investigation.
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PMID:Felodipine: a new dihydropyridine calcium-channel antagonist. 176 37

The clinical syndrome of unstable angina includes patients with the first onset of angina, change in a previous stable pattern or the development of chest pain at rest. Administration of intravenous nitroglycerin is established therapy in unstable angina. Buccal nitroglycerin has been introduced as an alternative means of administering nitroglycerin, which provides relief of anginal pain within 2 to 3 min and a sustained effect for 3 to 5 h. Twenty-nine patients admitted to the coronary care unit due to unstable angina were randomized to receive treatment with nitroglycerin i.v. for 24 h or buccal nitroglycerin every 4 h. Therapy was titrated according to haemodynamic effects. The mean dose of buccal nitroglycerin was 4.42 mg versus 0.45 micrograms.kg-1.min-1 in the intravenous group. The efficacy of treatment was similar in the two groups. Buccal nitroglycerin appeared to cause fewer adverse effects, especially less haemodynamic intolerance and headache, although the differences were not significant. Repeated administration of buccal nitroglycerin appears to be a safe and well tolerated alternative to high-dose i.v. nitroglycerin treatment in unstable angina pectoris.
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PMID:Buccal versus intravenous nitroglycerin in unstable angina pectoris. 178 77


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