A large scale comparative study in general practice with nitroglycerin spray and tablet formulations in elderly patients with angina pectoris.

In an 8-week comparative study, 410 patients were treated with nitroglycerin spray and 387 with conventional 500 mcg sublingual tablets. Data were analysed to compare the two treatments and to compare the results in older patients (greater than or equal to 65 y) with younger patients (less than 65 y). Spray was significantly superior to tablets in terms of number of patients helped, speed of pain relief and reduction in the number of attacks from pre-study levels. The occurrence of headache was significantly less in the spray group. There was no significant difference in the number or nature of adverse events but more spray patients reported taste disturbance. The clinical advantages seen in the entire population were maintained when the two age categories were considered separately. Further, 95% of patients found the spray convenient. The authors conclude that improved efficacy together with improved stability of the spray without loss of convenience makes Nitrolingual spray an acceptable alternative to tablets irrespective of patients' age.

Liver damage in long-term anticonvulsant therapy: a serological and histological study.

The prevalence of liver damage in patients receiving long-term anticonvulsant therapy was determined, using a new marker of liver disease, the serum F protein concentration. Abnormal serum F protein concentrations were detected in 50 per cent of 34 patients receiving anticonvulsant therapy. A retrospective analysis of post-mortem liver samples showed common histological abnormalities in three out of seven patients who had died whilst receiving anticonvulsant therapy. These changes were not seen in control patients. We suggest that chronic anticonvulsant therapy may cause significant hepatocellular damage.