Glyceryl Trinitrate

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Glyceryl Trinitrate is a treatment for Tendinopathy. It is applied to the degenerative area and may enhance collagen synthesis via the nitric oxide signaling molecule.

Formulations

There are two formulations in New Zealand.

• Patches - 5mg/24 hour or 10mg/24 hour Nitroderm TTS patches are available. The literature describes using one-fourth to one-half of one of these doses but if you cut Nitroderm the medication leaks out. One can try use the full 5mg/24 hour dose or put medical tape under a portion of it. The patches are fully funded.
• Ointment - 0.2% Rectogesic. This is not funded.

Evidence

There is no clear evidence of efficacy. A 2019 systematic review identified 10 eligible RCTs. There was improvement up to 6 months in pain, strength, and patient satisfaction with a mean effect size ranges from 0.12 to 0.26. It can be useful for all chronic tendinopathies as an adjunct to a loading programme. It can take up to 12 to 24 weeks to experience significant improvement.

Adverse effects

Head is the most common in up to one in five patients.

Contraindications

• Hypotension
• Migraine headaches
• Rosacea
• Head injury
• Severe anaemia
• Ingestion of phosphodiesterase inhibitors
• Ingestion of oral or sublingual nitroglycerin

Resources

Topical GTN for tendinopathies systematic review - Challoumas 2019 - 864 KB (f)

See Also

• Tendinopathy