- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01715220
Treatment of Suspected Cholelithiasis With Nitroglycerin
Treatment of Suspected Cholelithiasis With Nitroglycerin: a Randomized, Prospective Double-blind Trial
ABSTRACT: Sublingual nitroglycerin has been advocated for the treatment of acute pain from suspected symptomatic cholelithiasis. There is, however, no clinical studies that validate its use. This study is designed to evaluate the efficacy of nitroglycerine in relieving acute pain of suspected biliary tract origin.
Nitroglycerin is a potent smooth muscle relaxant used for biliary tract dilation during ERCP, (Chelly, J) and has been recommended for treatment of biliary colic based on anecdotal experience and small case reports. Nitroglycerin effect is a result of the nitric oxide component of the medication which acts as a smooth muscle relaxant in vascular, bronchial, esophageal and biliary smooth muscles. [McGowan(1936), Chelly (1979),Toyoyama (2001)] The typical dose of nitroglycerin is 0.4 mg given sublingually in pill form or, more recently, in a metered spray form. In a case series reported by Hassel (1993), positive response times ranged from 20 to 60 seconds with duration of action of two to twelve hours. Sublingual nitroglycerin is most commonly used for treatment of chest pain related to insufficient cardiac perfusion. It has also been noted to relieve the pain of esophageal spasms. Nitroglycerin has an excellent safety profile if used in patients with adequate pretreatment blood pressures. [Newberry (2005), Nitroglycerine (2011), Nitro (2011), Wolters (2009)] This study proposes to compare sublingual 0.4 mg doses of nitroglycerin to placebo for the initial treatment of acute pain from suspected symptomatic cholelithiasis
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
General Approach: This study proposes to compare sublingual 0.4 mg doses of nitroglycerin to placebo for initial treatment for acute pain from suspected symptomatic cholelithiasis. Patients with right upper quadrant abdominal pain of less than 24 hour duration between ages 18 and 60 years of age will be offered treatment with sublingual nitroglycerin or placebo. Patients with obstructive hypertrophic cardiomyopathy, pronounced hypovolemia, STEMI or presumed cardiac chest pain, inferior myocardial infarction with right ventricular involvement, raised intracranial pressure, cardiac tamponade, and patients taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), pregnancy, or with a known allergy to nitroglycerin will be excluded from the study.
2. Methods: A convenience sample of patients presenting to the Emergency Department will be randomized to receive either sublingual 0.4 mg doses of nitroglycerin or placebo. Pain prior to and at two minutes and five minutes after medication administration will be assessed using a visual analog scale. The medication will be either a 0.4 mg dose of nitroglycerin or a placebo. If pain is not completely relieved within five minutes, a second dose will be administered after blood pressure assessment. If the pain is not completely relieved after an additional two minute and five minute assessment or the pain returns, it will be treated in the standard manner at the discretion of the treating Emergency Physician. Ancillary studies and other treatments will be at the discretion of the treating physician. The 0.4mg dose of nitro has been proven to be a safe and well tolerated dose when administered to our patient population in treatment of acute coronary syndrome or suspected angina. Our attending, resident, and nursing staff are very familiar with this dose, the potential side effects of the medication, and its administration procedure. Therefore, we believe that 0.4mg will be a optimal starting dose for enrollees in our study.
3. Retrovirology Research: None
4. Investigational Drugs/Devices/Biologics Research: None
5. Statistical Analysis: Demographic information, patient characteristics, assignment to experimental group, and visual analog pain scale data will be entered into a spreadsheet . Pain will be recorded per patients at 5 time points: 0, 2, 5, 7, and 10 minutes. Descriptive statistics will be presented in tables and graphs. Pain scale results will be analyzed by a two-way (2x5) repeated measures analysis of variance with interaction and post hoc multiple comparisons. The primary time pair to be tested will be the difference between treatment and placebo groups in pain reduction from 0 to 2 minutes. The planned sample size is 62, with 31 in the placebo group and 31 in the nitro group. The sample size was calculated with the aid of Dr Riffenburgh. He agrees with sample size suggested above.
6. Military Relevance / Operational Use, if any: Sublingual nitroglycerin is a standard AMAL list item for independent providers in most field and operational settings. Relief of biliary colic can significantly reduce the number of urgent medical evacuations for right upper quadrant pain. There is also no mental status degradation with the use of nitroglycerin, unlike the opioids commonly used to treat biliary colic.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: steven j portouw, MD
- Phone Number: 619-532-8274
- Email: steven.portouw@med.navy.mil
Study Locations
-
-
California
-
San Diego, California, United States, 92134
- Recruiting
- Naval Medical Center San Diego
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria: Patients with right upper quadrant abdominal pain of less than 24 hours' duration between ages 18 and 60 years of age will be offered treatment with sublingual nitroglycerin or placebo.
Exclusion Criteria: Patients with obstructive hypertrophic cardiomyopathy, pronounced hypovolemia, alcohol use in the last 8 hours, clinical intoxication, STEMI or presumed cardiac chest pain, inferior myocardial infarction with right ventricular involvement, raised intracranial pressure, cardiac tamponade and patients taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), pregnancy or with a known allergy to nitroglycerin will be excluded from the study. Patients unable to give consent will be excluded.
-
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Sublingual nitroglycerine
Sublingual nitroglycerine followed by pain assessment and if necessary second dose of sublingual nitroglycerine
|
A convenience sample of patients presenting to the Emergency Department will be randomized to receive either sublingual 0.4 mg doses of nitroglycerin or placebo.
Pain prior to and at two minutes and five minutes after medication administration will be assessed using a visual analog scale.
The medication will be either a 0.4 mg dose of nitroglycerin or a placebo.
If pain is not completely relieved within five minutes, a second dose will be administered after blood pressure assessment.
If the pain is not completely relieved after an additional two minute and five minute assessment or the pain returns, it will be treated in the standard manner at the discretion of the treating Emergency Physician
Other Names:
|
Placebo Comparator: placebo
sublingual placebo followed by pain assessment and if necessary second dose of sublingual placebo
|
A convenience sample of patients presenting to the Emergency Department will be randomized to receive either sublingual 0.4 mg doses of nitroglycerin or placebo.
Pain prior to and at two minutes and five minutes after medication administration will be assessed using a visual analog scale.
The medication will be either a 0.4 mg dose of nitroglycerin or a placebo.
If pain is not completely relieved within five minutes, a second dose will be administered after blood pressure assessment.
If the pain is not completely relieved after an additional two minute and five minute assessment or the pain returns, it will be treated in the standard manner at the discretion of the treating Emergency Physician
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
pain relief on visual analog scale
Time Frame: two and five minutes
|
pain relief assesement at two and five minutes after medication or placebo with standard treatment if inadequate pain relief.
|
two and five minutes
|
Collaborators and Investigators
Investigators
- Principal Investigator: Steven J Portouw, MD, United States Naval Medical Center, San Diego
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NMCSD.2012.0003
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on COLIC
-
SOFAR S.p.A.CompletedInfantile Colic | Colic, InfantileItaly
-
University of NebraskaiHealthTerminatedInfantile ColicUnited States
-
Lallemand Health SolutionsProbiSearch SLWithdrawn
-
BioGaia ABHopital Universitaire Robert-Debre; Association Clinique Thérapeutique Infantile... and other collaboratorsWithdrawnInfantile ColicFrance
-
Nordic Institute of Chiropractic and Clinical BiomechanicsResearch Unit of General Practice, OdenseCompleted
-
Innovacion y Desarrollo de Estrategias en SaludBioGaia ABUnknown
-
University of SevilleCompleted
-
University of BariAntonio Di Mauro; Ruggiero Francavilla; Lorenzo TrovèUnknown
-
Nordic Institute of Chiropractic and Clinical BiomechanicsUniversity of Southern Denmark; Foundation for the Advancement of Chiropractic...TerminatedInfantile ColicDenmark
-
Menarini GroupWithdrawn
Clinical Trials on sublingual nitroglycerine
-
University of MichiganNational Heart, Lung, and Blood Institute (NHLBI)CompletedRheumatoid ArthritisUnited States
-
Danish Headache CenterEUROHEADCompletedFamilial Hemiplegic MigraineDenmark
-
Medical University of LodzUnknownAllergic Rhinitis | Bronchial AsthmaPoland
-
Stallergenes GreerCompletedPrimary DiseaseFrance, Italy, Spain
-
Stallergenes GreerCompletedAllergic Rhinitis Due to Grass PollensUnited States
-
ALK-Abelló A/SActive, not recruitingAllergic Rhinitis Due to Dermatophagoides Farinae | Allergic Rhinitis Due to Dermatophagoides Pteronyssinus | Allergic Rhinitis Due to House Dust MiteSpain, Russian Federation, United States, Poland, Bulgaria, Canada, France, Germany, Lithuania, Slovakia, Ukraine
-
Bispebjerg HospitalLund University; University of Copenhagen; ALK-Abelló A/SCompletedThe Effect of Allergen Immunotherapy on Anti-viral Immunity in Patients With Allergic Asthma (VITAL)Allergic Asthma Due to Dermatophagoides PteronyssinusDenmark
-
Inmunotek S.L.CompletedRhinitis | RhinoconjunctivitisSpain
-
HAL AllergyCompletedBirch Pollen Allergy | Seasonal Rhinitis and/or RhinoconjunctivitisGermany
-
Zagazig UniversityNot yet recruitingAllergic Rhinitis