Reader Question: Nitro Patches for Tendinopathy
9 Mar, 08 | by Karim Khan
A Reader of the BJSM Blog Asks:
Nitro Patches for Tendinopathy?
I am quite intrigued by this, not only as a physician but more so as a patient with some current injuries. Would you be so kind as to reply with a source that might describe the mechanis(s) of action as well as a link or two to get more detail.
Answer:
Although the precise mechanism is not known, cell culture studies suggest that Nitric Oxide (NO) has a direct stimulating effect on collagen synthesis. For a background to the discussion and direction to the clinical papers on the effectiveness of nitro patches, please see Dr Murrell’s summary in the BJSM Tendinopathy Issue (April 2007).
I have found the nitro patches to be very useful. I start them at 1/2 of the recommended dose (so 1/4 of a 0.2 mg patch) to avoid the headaches and then I have them increase the dose slowly.
I am amazed by how many patients go for tendon surgery before trying the patches. Why would you do that when the quality of evidence for this medication is high; the results of tendon surgery unpredictable at best.
David Brakes
March 16th, 2008 at 11:20 pm