Oesophageal spasm and glyceryl trinitrate

[admin]

Has anyone come across this situation before?

Today a man came into the pharmacy (aged 40 to 45, non smoker, not overweight) and said he was suffering with oesophageal spasm due to acid reflux, and his GP has advised him to purchase some GTN tablets. His regular medication was amitryptilline and pantoprazole. His GP had just increased his pantoprazole dose from 20mg to 40mg daily.

After speaking to him for a few minutes I dscovered that he had previously had tests for angina, had no idea of the dose he was supposed to take or if he was to take this drug on a regular basis or as he experienced symptoms (chest pain). He told me all his angina tests were negative.

I was concerned that this was an unlicenced use of GTN tablets, but when he realised that their normal use was for angina, he immediately rejected the idea of using this drug, so opted to buy a bottle of gaviscon instead. He said he had an appointment with his consultant in February, and preferred to ask him about this. I felt this was a good idea, as he hadn't given the increase in pantoprazole chance to work, and I wondered why the GP had not prescribed him GTN tablets with a stated dose (I could only think of the cost).

I found this on the British Heart Foundation website: -

Oesophagael or Gastric pain
This often occurs as a pain or burning sensation beneath your breast bone (sternum) and the sensation is quite similar to heart pain. It might happen after you have been eating and tends to last quite a while, although oesophageal spasm attacks can be brief. It isn’t usually associated with physical exertion, but can be brought on when you change posture, for example lying down or bending forward. Oesophageal spasms can be relieved with GTN spray or tablets.

There are quite a few articles on the use of this GTN for this type of problem on the internet, but at first glance it seems to me that these drugs have been anecdotally successful in the management of oesophageal spasm.

The obvious concern for anyone suffering chest pain is that it is cardiac in origin, and telling a patient to purchase a drug that is commonly used for angina would seem to possibly reinforce their fear that this is the true cause, however many tests they have previously found to be negative.

Has anyone any experience of GTN being used in patients for this type of problem?

Thanks