Glyceryl trinitrate heart failure

In a randomized, open, parallel-group study of the hemodynamic effects of milrinone and glyceryl trinitrate in 119 patients with advanced decompensated heart failure, milrinone was significantly more effective than glyceryl trinitrate (7). Adverse effects caused the withdrawal of milrinone in three of the 58 patients who took it one had ventricular extra beats, one had renal insufficiency, and one had hypokalemia. Headache was the most common adverse effect in both groups, but was less common in those who took milrinone (12 versus 29%). 

High-dose transdermal glyceryl trinitrate 50-100 mg given over a period of 12 hours each day for 3 months improved exercise tolerance and left ventricular systolic function in 29 patients with congestive heart failure taking a long-term ACE inhibitor (17). The most frequent adverse effects were skin irritation at the site of patch application and headache, which caused premature glyceryl trinitrate withdrawal in three patients. 

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