Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 Hi Pippa. I miss you!  ________________________________ From: manchesterpippa <manchesterpippa@...> achalasia Sent: Wednesday, February 29, 2012 11:05 AM Subject: FAO Notan - GTN Spray  Notan can I ask in your research for chest pains, (Spasms) is GTN spray as good as Nifedipine? I had Nifedipine when I was in hospital (in 2006) and all it did was give me a chronic headache so can't take that so been prescribed a GTN spray, is there any other medication that can be used? Have been warned that the GTN spray may drop my blood pressure and make me light headed but should work on the spasm within seconds. Pippa Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 I have a bottle of spray in my cupboard that I am scared to use... Sent from my CrackBerry® powered by Virgin Mobile. FAO Notan - GTN Spray Notan can I ask in your research for chest pains, (Spasms) is GTN spray as good as Nifedipine? I had Nifedipine when I was in hospital (in 2006) and all it did was give me a chronic headache so can't take that so been prescribed a GTN spray, is there any other medication that can be used? Have been warned that the GTN spray may drop my blood pressure and make me light headed but should work on the spasm within seconds. Pippa Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 Pippa wrote: > > ... is GTN spray as good as Nifedipine? > Glyceryl trinitrate (GTN) is an alternative name for the chemical nitroglycerin. GTN can cause severe headaches and drops in blood pressure. You won't know until you try it. GTN is a nitrate while Nifedipine is a calcium-channel blocker. They are in different classes of drugs but the headache from either could be because of blood pressure and blood vessel issues. Both are known to work for some people with spasm pain but not for everyone. The spry version should work very fast. You may want to be sitting down. There are a number of drugs that can be used. I started working on a message about this last summer before my accident and I just have never gotten around to finishing it. For no good reason I find it hard to work on old stuff. I will post some of it here but understand that it is just a draft of ongoing work and may have some errors. Toward the bottom are some things that just look like a mess. These are notes to myself about things I want to look up and expand on. ========================================================================= There are true spasms which are constrictions of the esophageal muscles. Spasms are a type of Non Cardiac Chest Pain (NCCP), but not all the NCCPs we have are spasms. The muscles spasming are probably smooth muscles but there is another type of muscles in the esophagus too. NCCPs could also be from nerve dysfunction, esophagitis, and even acid reflux. There are also other sources of identical pain that may have nothing to do with achalasia. For true spasms drugs that affect muscles are often prescribed, including: Calcium-Channel Blockers (CCBs) Anticholinergics Nitrates Other types of muscle relaxers Sometimes NCCPs are treated by drugs that affect nerve functions for the perception of pain, including: Antidepressants Anticonvulsants Narcotics If the source of, or a contributing factor of, NCCPs and spasms is known or suspected to be acid reflux or esophagitis medication to treat those conditions may be used, including: PPIs H2 blocker Here is some information on the types of medications listed above, but it isn't meant to be comprehensive. The dosages listed are generally for other uses and not specific to treating spasms and may not be appropriate. Where I could find a message from this support group where someone indicated how much they used I include that amount. Calcium-Channel Blockers (CCBs) =========================================== CCBs relax (to some extent) smooth muscles. They are most commonly used to treat high blood pressure and angina because the blood vessels and heart have smooth muscles. Because they relax smooth muscles they also relax the smooth muscles of the esophagus. When relaxing the esophagus they can also cause low blood pressure, affect heart rate, cause head aches and relax muscles in other parts of the body especially in the gut. Often these effects are not noticeable, or only happen at first, but with the more powerful ones head aches are a common problem. The benefit of CCBs for spasms and to relax the LES seem to diminish with use over time. Here are some of the CCBs used for spasms: Iproveratril Hydrochloride (Calan, Covera, Isoptin and Verapamil) : Comes in regular and extended release forms. The regular form works for 3 to 4 hrs. The extended release form is taken once or twice a day. The extend form would be to prevent spasms and the regular form would be to stop one that has started. Sometimes it is also used before meals to relax and open the LES. Do not crush, but you can open the capsules forms. Half-life 2.8-7.4 hours. Dose 2.5 to 400 mg. Use of 120 mg reported in this support group. Nifedipine (Adalat, Cordipin, Nifediac, Nifedical, and Procardia): Is fast acting with strong side effects. Intense head ache is often reported. It comes in extended release tablets, immediate release capsules. Immediate release forms may also be used sublingually. Use the immediate release forms to stop a spasm that has started. Also used before meals to relax and open the LES. Dose 10 to 90 mg. 30mg extended release use was reported in this group, but most people in this group report using it immediate release sublingually. half-life is 7 hrs (extended release) and 2 hrs (immediate release). Diltiazem (Cardizem, Cartia, Dilacor, Dilt, Diltia, Diltzac, Matzim, Taztia, Tiamate, Tiazac and more) not to be confused with epam. Diltiazem comes in regular and extended-release forms. Usage is similar to the other CCBs. Dose 30 to 420 mg. 90 mg twice or three times per day was reported in this support group. Half-life 3-4.5 hours. =========================================== Nitrates =========================================== Nitrates are converted to nitric oxide (NO) in the body. Some of the nerves that are damaged and destroyed in achalasia use NO as a neurotransmitter to signal relaxation of the smooth muscles in the lower esophagus and LES. Nitrates provide the NO for the relaxation signal that the damaged nerves can not. Smooth muscles throughout the body use NO this way causing nitrates to have a lot of side effect. With long-term use the side effects often diminish or disappear, but the esophageal benefit often diminishes too. Isosorbide dinitrate (Cedocard, Dilatrate, ISDN, Isordil, Isotrate, Sorbitrate, ) Half-life 1 hour. Isosorbide mononitrate (Chemydur, ISMO, Isosorb Mono, Monit, Monosorb, Monotrate, Solotrate) Half-life 5 hours. Nitroglycerin or Glyceryl Trinitrate (Nitrospan, Nitrostat, Nitrol, and Tridil - patches as: Trinipatch, Transderm Nitro, Nitro-Dur - sublingual as: Nitrolingual Pump Spray, Natispray, and NitroMist) Nitroglycerin comes in forms of tablets, sprays or patches. Half-life 3 minutes. =========================================== Anticholinergics =========================================== Anticholinergics are a type of antispasmodic that blocks the neurotransmitter acetylcholine. The contraction of muscles in the esophagus, and other parts of the body are triggered by nerves that use the neurotransmitter acetylcholine to signal the contractions. Spasms and pressure at the LES are the result of contracting muscles. As the signals for these contraction are reduced the strength and pressure of them is also reduced. The contraction of peristalsis are also signaled this way so anticholinergics also effect peristalsis, other GI motility and contractions in other parts of the body. Donatal Dicyclomine or Dicycloverine (Byclomine, Bentyl, Dibent, Di-Spaz, Dilomine, Bentylol, Formulex, Lomine, Merbentyl, Spasmo) (also Kolanticon, in the UK, which also contains an anti-foaming agent and two antacids) Half-life 5 hrs. Hyoscamine Hyoscyamine (Symax, HyoMax, Anaspaz, Buwecon, Cystospaz, Levsin, Levbid, Levsinex, Donnamar, NuLev (or Nu-Lev), Spacol, Neoquess) Levsin is available in sublingual tablets Mebeverine (Colofac, Duspatal, Duspatalin) Mebeverine is a muscolotropic spasmolytic which means it affects acetylcholine and muscles differently than some of the other anticholinergic antispasmodics. The effects are much more selective to smooth muscles of the gut than other anticholinergics that affect many parts of the body and nervous system. Promethazine of the Phenothiazine family. (Phenergan) It is an antihistamine. That may reduce some inflammation in the esophagus and calm it down. It is also an antiemetic (prevents nausea and motion sickness) so it acts on part of the nervous system that responds to stimulus in the stomach, and esophagus. It is also an anticholinergic which means it calms muscles and weakens spasms. It is also a strong sedative. It is also a weak antipsychotic so if achalasia is driving you nuts maybe it helps. =========================================== Other types of muscle relaxers (Antispasmodics) =========================================== For achalasia this usually means benzodiazepines, such as diazepam. Benzodiazepines increase the action of the neurotransmitter gamma-aminobutyric acid (GABA). Among other things GABA does is it increase the action of the nerves that relax the smooth muscles of the esophagus and LES. Benzodiazepines make GABA act even stronger to relax the smooth muscles. epam Cyclobenzaprine (Flexaril) Works for some and not for others in our group. Can make you sleepy. Lorazepam 1mg - 2.5 reported =========================================== Antidepressants =========================================== =========================================== Anticonvulsants =========================================== =========================================== Narcotics =========================================== Dilaudid Paregoric A weak opium based drug. The formulation and strength differ by country. =========================================== PPIs and H2 blockers =========================================== =========================================== epam comes as a tablet, extended-release (long-acting) capsule, and concentrate (liquid) Levsin is available in sublingual tablets Medalolam vicodin 500mg Ordine Other common spasmolytic agents include: methocarbamol, carisoprodol, chlorzoxazone, cyclobenzaprine, gabapentin, metaxalone, and orphenadrine. Spasmolytics like carisoprodol, cyclobenzaprine, metaxalone, methocarbamol, tizanidine beta-blockers, beta-adrenergic agonists (carbuterol, terbutaline, cimetropium bromide), nitroglycerine, and theophylline (aminophylline) Levbid verapamil oxycontine diladid Librax Zelnorm Trazadone Medazalam Paxil, Ativan, Nortryptaline imipramine Imdur Glycocarn Propulsives Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 Notan Great information, I printed it out in case I ever need it. When my A started 5 years I got spasms, but very rarely now. My secret today is Magnesium and butter. When I get them it is at lunch, when food is in the e, once I clear the food out with a Coke , they go away. Never at night. What I wonder if they " only start " while food is in the e? Any comments on this? I work hard on cleaning out the e. Yes I was desperate at times and considered ending it all, but my wife of 58 years was very precious to me. I am so sorry for all the kids who get this terrible disease. It is so hard to read. Ray > > > > ... is GTN spray as good as Nifedipine? > > > > Glyceryl trinitrate (GTN) is an alternative name for the chemical > nitroglycerin. GTN can cause severe headaches and drops in blood > pressure. You won't know until you try it. GTN is a nitrate while > Nifedipine is a calcium-channel blocker. They are in different classes > of drugs but the headache from either could be because of blood pressure > and blood vessel issues. Both are known to work for some people with > spasm pain but not for everyone. The spry version should work very fast. > You may want to be sitting down. There are a number of drugs that can be > used. I started working on a message about this last summer before my > accident and I just have never gotten around to finishing it. For no > good reason I find it hard to work on old stuff. I will post some of it > here but understand that it is just a draft of ongoing work and may have > some errors. Toward the bottom are some things that just look like a > mess. These are notes to myself about things I want to look up and > expand on. > > ========================================================================= > > > There are true spasms which are constrictions of the esophageal muscles. > Spasms are a type of Non Cardiac Chest Pain (NCCP), but not all the > NCCPs we have are spasms. The muscles spasming are probably smooth > muscles but there is another type of muscles in the esophagus too. NCCPs > could also be from nerve dysfunction, esophagitis, and even acid reflux. > There are also other sources of identical pain that may have nothing to > do with achalasia. > > For true spasms drugs that affect muscles are often prescribed, including: > > Calcium-Channel Blockers (CCBs) > Anticholinergics > Nitrates > Other types of muscle relaxers > > > Sometimes NCCPs are treated by drugs that affect nerve functions for the > perception of pain, including: > > Antidepressants > Anticonvulsants > Narcotics > > If the source of, or a contributing factor of, NCCPs and spasms is > known or suspected to be acid reflux or esophagitis medication to treat > those conditions may be used, including: > > PPIs > H2 blocker > > Here is some information on the types of medications listed above, but > it isn't meant to be comprehensive. The dosages listed are generally for > other uses and not specific to treating spasms and may not be > appropriate. Where I could find a message from this support group where > someone indicated how much they used I include that amount. > > Calcium-Channel Blockers (CCBs) > =========================================== > CCBs relax (to some extent) smooth muscles. They are most commonly used > to treat high blood pressure and angina because the blood vessels and > heart have smooth muscles. Because they relax smooth muscles they also > relax the smooth muscles of the esophagus. When relaxing the esophagus > they can also cause low blood pressure, affect heart rate, cause head > aches and relax muscles in other parts of the body especially in the > gut. Often these effects are not noticeable, or only happen at first, > but with the more powerful ones head aches are a common problem. The > benefit of CCBs for spasms and to relax the LES seem to diminish with > use over time. Here are some of the CCBs used for spasms: > > Iproveratril Hydrochloride (Calan, Covera, Isoptin and Verapamil) : > Comes in regular and extended release forms. The regular form works for > 3 to 4 hrs. The extended release form is taken once or twice a day. The > extend form would be to prevent spasms and the regular form would be to > stop one that has started. Sometimes it is also used before meals to > relax and open the LES. Do not crush, but you can open the capsules > forms. Half-life 2.8-7.4 hours. Dose 2.5 to 400 mg. Use of 120 mg > reported in this support group. > > Nifedipine (Adalat, Cordipin, Nifediac, Nifedical, and Procardia): Is > fast acting with strong side effects. Intense head ache is often > reported. It comes in extended release tablets, immediate release > capsules. Immediate release forms may also be used sublingually. Use the > immediate release forms to stop a spasm that has started. Also used > before meals to relax and open the LES. Dose 10 to 90 mg. 30mg extended > release use was reported in this group, but most people in this group > report using it immediate release sublingually. half-life is 7 hrs > (extended release) and 2 hrs (immediate release). > > Diltiazem (Cardizem, Cartia, Dilacor, Dilt, Diltia, Diltzac, Matzim, > Taztia, Tiamate, Tiazac and more) not to be confused with epam. > Diltiazem comes in regular and extended-release forms. Usage is similar > to the other CCBs. Dose 30 to 420 mg. 90 mg twice or three times per day > was reported in this support group. Half-life 3-4.5 hours. > > =========================================== > > Nitrates > =========================================== > Nitrates are converted to nitric oxide (NO) in the body. Some of the > nerves that are damaged and destroyed in achalasia use NO as a > neurotransmitter to signal relaxation of the smooth muscles in the lower > esophagus and LES. Nitrates provide the NO for the relaxation signal > that the damaged nerves can not. Smooth muscles throughout the body use > NO this way causing nitrates to have a lot of side effect. With > long-term use the side effects often diminish or disappear, but the > esophageal benefit often diminishes too. > > Isosorbide dinitrate (Cedocard, Dilatrate, ISDN, Isordil, Isotrate, > Sorbitrate, ) > Half-life 1 hour. > > Isosorbide mononitrate (Chemydur, ISMO, Isosorb Mono, Monit, Monosorb, > Monotrate, Solotrate) > Half-life 5 hours. > > Nitroglycerin or Glyceryl Trinitrate (Nitrospan, Nitrostat, Nitrol, and > Tridil - patches as: Trinipatch, Transderm Nitro, Nitro-Dur - sublingual > as: Nitrolingual Pump Spray, Natispray, and NitroMist) Nitroglycerin > comes in forms of tablets, sprays or patches. > Half-life 3 minutes. > =========================================== > > Anticholinergics > =========================================== > Anticholinergics are a type of antispasmodic that blocks the > neurotransmitter acetylcholine. The contraction of muscles in the > esophagus, and other parts of the body are triggered by nerves that use > the neurotransmitter acetylcholine to signal the contractions. Spasms > and pressure at the LES are the result of contracting muscles. As the > signals for these contraction are reduced the strength and pressure of > them is also reduced. The contraction of peristalsis are also signaled > this way so anticholinergics also effect peristalsis, other GI motility > and contractions in other parts of the body. > > Donatal > > Dicyclomine or Dicycloverine (Byclomine, Bentyl, Dibent, Di-Spaz, > Dilomine, Bentylol, Formulex, Lomine, Merbentyl, Spasmo) (also > Kolanticon, in the UK, which also contains an anti-foaming agent and two > antacids) Half-life 5 hrs. > > Hyoscamine > > Hyoscyamine (Symax, HyoMax, Anaspaz, Buwecon, Cystospaz, Levsin, Levbid, > Levsinex, Donnamar, NuLev (or Nu-Lev), Spacol, Neoquess) > Levsin is available in sublingual tablets > > Mebeverine (Colofac, Duspatal, Duspatalin) Mebeverine is a muscolotropic > spasmolytic which means it affects acetylcholine and muscles > differently than some of the other anticholinergic antispasmodics. The > effects are much more selective to smooth muscles of the gut than other > anticholinergics that affect many parts of the body and nervous system. > > Promethazine of the Phenothiazine family. (Phenergan) > It is an antihistamine. That may reduce some inflammation in the > esophagus and calm it down. It is also an antiemetic (prevents nausea > and motion sickness) so it acts on part of the nervous system that > responds to stimulus in the stomach, and esophagus. It is also an > anticholinergic which means it calms muscles and weakens spasms. It is > also a strong sedative. It is also a weak antipsychotic so if achalasia > is driving you nuts maybe it helps. > > > =========================================== > > Other types of muscle relaxers (Antispasmodics) > =========================================== > For achalasia this usually means benzodiazepines, such as diazepam. > Benzodiazepines increase the action of the neurotransmitter > gamma-aminobutyric acid (GABA). Among other things GABA does is it > increase the action of the nerves that relax the smooth muscles of the > esophagus and LES. Benzodiazepines make GABA act even stronger to relax > the smooth muscles. > > epam > > Cyclobenzaprine (Flexaril) Works for some and not for others in our > group. Can make you sleepy. > > Lorazepam > 1mg - 2.5 reported > > =========================================== > > Antidepressants > =========================================== > =========================================== > > Anticonvulsants > =========================================== > =========================================== > > Narcotics > =========================================== > Dilaudid > > Paregoric > A weak opium based drug. The formulation and strength differ by country. > =========================================== > PPIs and H2 blockers > =========================================== > =========================================== > > epam comes as a tablet, extended-release (long-acting) capsule, and > concentrate (liquid) > > Levsin is available in sublingual tablets > > Medalolam > > vicodin 500mg > Ordine > > Other common spasmolytic agents include: methocarbamol, carisoprodol, > chlorzoxazone, cyclobenzaprine, gabapentin, metaxalone, and orphenadrine. > Spasmolytics like carisoprodol, cyclobenzaprine, metaxalone, > methocarbamol, tizanidine > > beta-blockers, > beta-adrenergic agonists (carbuterol, terbutaline, cimetropium bromide), > nitroglycerine, and theophylline (aminophylline) > > Levbid > verapamil > > oxycontine > diladid > > > Librax > Zelnorm > Trazadone > > Medazalam > > Paxil, Ativan, Nortryptaline > > imipramine > > Imdur > > Glycocarn > > Propulsives > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2012 Report Share Posted February 29, 2012 Ray wrote: > > My secret today is Magnesium and butter. > Thanks for the info. > I am so sorry for all the kids who get this terrible disease. It is so > hard to read. > Yes, not rare enough. notan Quote Link to comment Share on other sites More sharing options...
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