Effect of glyceryl trinitrate on the sphincter of Oddi spasm evoked by prostigmine-morphine administration.
OBJECTIVE
In this study the effect of glyceryl trinitrate on the prostigmine-morphine-induced sphincter of Oddi spasm was evaluated in nine female patients with sphincter of Oddi dyskinesia.


METHODS
Sphincter of Oddi spasm was induced by prostigmine-morphine administration (0.5 mg prostigmine intramuscularly and 10 mg morphine subcutaneously) and visualized by quantitative hepatobiliary scintigraphy. The entire procedure was repeated during glyceryl trinitrate infusion (Nitrolingual 1 microg/kg/min for 120 min).


RESULTS
Prostigmine-morphine provocation caused significant increases in the time to peak activity (Tmax) over the hepatic hilum (HH: 34.33 +/- 5.05 vs. 22.77 +/- 3.26) and the common bile duct (CBD: 60.44 +/- 5.99 vs. 40.0 +/- 2.88) and in the half-time of excretion (T1/2) over the liver parenchyma (LP: 120.04 +/- 16.01 vs. 27.37 +/- 2.19), HH (117.61 +/- 14.71 vs. 31.85 +/- 3.99) and CBD (158.11 +/- 9.18 vs. 40.1 +/- 6.24), indicating a complete spasm at the level of the sphincter of Oddi. Glyceryl trinitrate infusion completely normalized the prostigmine-morphine-induced alterations in these quantitative parameters (TmaX over the LP: 11.33 +/- 1.13; over the HH: 18.88 +/- 1.48; and over the CBD: 36.22 +/- 1.92; and T1/2 over the LP: 28.21 +/- 1.83; over the HH: 33.42 +/- 3.10; and over the CBD: 41.66 +/- 6.33), suggesting an effective sphincter-relaxing effect of glyceryl trinitrate.


CONCLUSIONS
These results provide the first evidence of the effectiveness of glyceryl trinitrate on the morphine-induced sphincter of Oddi spasm in humans. Since glyceryl trinitrate is able to overcome even the drastic effect of morphine, it might be of relevance in the treatment of sphincter of Oddi dyskinesia.
Velosy
B
B
First Department of Medicine, Albert Szent-Györgyi Medical University, Szeged, Hungary.
Madácsy
L
L
Lonovics
J
J
Csernay
L
L
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001219:Aspartate Aminotransferases / Q000032:analysis; D001659:Biliary Tract / Q000000981:diagnostic imaging / Q000502:physiology; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009388:Neostigmine / Q000008:administration & dosage*; D005996:Nitroglycerin / Q000494:pharmacology*; D011877:Radionuclide Imaging; D013035:Spasm / Q000139:chemically induced / Q000188:drug therapy*; D009803:Sphincter of Oddi / Q000000981:diagnostic imaging / Q000187:drug effects*; D014665:Vasodilator Agents / Q000494:pharmacology
D000701:Analgesics, Opioid; D002800:Cholinesterase Inhibitors; D014665:Vasodilator Agents; D009388:Neostigmine; D009020:Morphine; D001219:Aspartate Aminotransferases; D005996:Nitroglycerin