Nitrate patches
What are nitrate patches?
Used primarily for improving blood supply to the heart, nitrate patches have been recently shown to improve healing in chronic tendon injuries. Please refer to the abstracts below.
Are there any side effects?
Headache is the main side effect, although some people may experience small drops in blood pressure. These effects are minimal if 1/4 of a 5mg/24hr patch daily is used (which can be done with the brands NitroDur and MiniTran - other patches cannot be cut into quarters as they contain cream). The medication is incompatible with other vasodilators such as Viagra and similar drugs.
Topical nitric oxide application in the treatment of
chronic extensor tendinosis at the elbow: a randomized, double-blinded,
placebo-controlled clinical trial.
Am J Sports Med. 2003 Nov-Dec;31(6):915-20.
Paoloni JA, Appleyard RC, Nelson J, Murrell GA.
BACKGROUND: Extensor tendinosis ("tennis elbow") is a degenerative overuse
tendinopathy of the wrist extensors at their attachment to the lateral humeral
epicondyle. No treatment has been universally successful. Topical application of
nitric oxide has been used effectively to treat fractures and cutaneous wounds
in animal models, presumably by stimulation of collagen synthesis in
fibroblasts. PURPOSE: To determine whether topical nitric oxide can improve
outcome of patients with extensor tendinosis. STUDY DESIGN: Prospective,
randomized, double-blinded clinical trial. METHODS: Eighty-six patients with
extensor tendinosis were randomized into two equal groups; both were instructed
to perform a standard tendon rehabilitation program. One group received an
active glyceryl trinitrate transdermal patch, and the other group received a
placebo patch. RESULTS: Patients in the glyceryl trinitrate group had
significantly reduced elbow pain with activity at 2 weeks, reduced epicondylar
tenderness at 6 and 12 weeks, and an increase in wrist extensor mean peak force
and total work at 24 weeks. At 6 months, 81% of treated patients were
asymptomatic during activities of daily living, compared with 60% of patients
who had tendon rehabilitation alone. CONCLUSIONS: Application of topical nitric
oxide improved early pain with activity, late functional measures, and outcomes
of patients with extensor tendinosis.
Topical glyceryl trinitrate treatment of chronic
noninsertional achilles tendinopathy. A randomized, double-blind,
placebo-controlled trial.
J Bone Joint Surg Am. 2004 May;86-A(5):916-22
Paoloni JA, Appleyard RC, Nelson J, Murrell GA.
BACKGROUND: Noninsertional Achilles tendinopathy is a degenerative overuse
disorder. No method has been universally successful in treating this condition.
Topically applied nitric oxide has been shown, in animal models, to be effective
for the treatment of fractures and cutaneous wounds through mechanisms that may
include stimulation of collagen synthesis in fibroblasts. The goal of the
present study was to determine if topical glyceryl trinitrate improves clinical
outcome measures in patients with Achilles tendinopathy. METHODS: A prospective,
randomized, double-blind, placebo-controlled trial involving a total of
sixty-five patients (eighty-four Achilles tendons) was performed to compare
continuous application of topical glyceryl trinitrate (at a dosage of 1.25 mg
per twenty-four hours) with rehabilitation alone for the treatment of
noninsertional Achilles tendinopathy. RESULTS: Compared with the control group,
the glyceryl trinitrate group showed reduced pain with activity at twelve weeks
(p = 0.02) and twenty-four weeks (p = 0.03), reduced night pain at twelve weeks
(p = 0.04), reduced tenderness at twelve weeks (p = 0.02), decreased pain scores
after the hop test at twenty-four weeks (p = 0.005), and increased ankle plantar
flexor mean total work compared with the baseline level at twenty-four weeks (p
= 0.04). Twenty-eight (78%) of thirty-six tendons in the glyceryl trinitrate
group were asymptomatic with activities of daily living at six months, compared
with twenty (49%) of forty-one tendons in the placebo group (p = 0.001,
chi-square analysis). The mean effect size for all outcome measures was 0.14.
CONCLUSIONS: Topical glyceryl trinitrate significantly reduced pain with
activity and at night, improved functional measures, and improved outcomes in
patients with Achilles tendinopathy.
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