Monday Pharmaceutical Mystery: July 20

As you are rushing back to the pharmacy from your daily restroom break, a patient stops you in the first aid aisle. “What can I get to help me attach these patches to my foot?” he asks. You look at him in disbelief. He is holding a box of nitroglycerin patches!

You ask him what he is using the patches for, and get mentally prepared for a counseling session to explain that nitroglycerin patches go on the chest, not the foot. Alas, he tells you that his orthopedist indeed prescribed nitroglycerin patches for heel tendonitis.

Mystery: Can nitroglycerin patches be used to treat tendonitis?

Solution: Your patient shows you the notes from his orthopedist. He has Achilles tendonitis, an overuse injury of the Achilles tendon, a band of tissue connecting the calf muscle to the heel bone. Symptoms include aches, tenderness, and stiffness, often in the morning. Achilles tendonitis is usually treated with OTC or prescription-strength NSAIDs such as naproxen or ibuprofen, physical therapy, or orthotics.¹

Although NSAIDs are common, there is some literature about topical nitroglycerin (patches or ointment) for the treatment of tendonitis.²

A review and meta-analysis found that topical nitroglycerin has shown a positive effect in the reduction of pain during activities of daily living in patients with acute or chronic tendinopathies as well as an increase in tendon strength. Other advantages of topical nitroglycerin include:

• Increased compliance due to ease of application and reasonable cost
• Reduced risk of more invasive procedures like injections or surgery
• Less adverse effects by avoiding NSAID use²

REFERENCES

• Mayo Clinic. Achilles tendonitis. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/achilles-tendinitis/symptoms-causes/syc-20369020 Accessed July 10, 2020.
• Gambito ED, Gonzalez-Suarez CB, Oquinena TI, Agbayani RB. Evidence on the Effectiveness of Topical Nitroglycerin in the Treatment of Tendinopathies: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2010;91(8):1291-1305. https://www.archives-pmr.org/article/S0003-9993(10)00121-8/pdf Accessed July 10, 2020.