Determination of nitroglycerin and its dinitrate metabolites in urine by gas chromatography-mass spectrometry as potential biomarkers for occupational exposure.

This paper describes a method for the quantitative analysis of nitroglycerin and its dinitrate metabolites (1,2- and 1,3-glycerol dinitrate) in urine. After liquid-liquid extraction the analytes were separated and quantified using gas chromatography-mass spectrometry with negative ion chemical ionisation. The method can detect above 0.3 nmol/l for all analytes and is linear over the range of at least 0-44 nmol/l. The method was then used to determine metabolite levels in a subject using nitroglycerin therapeutically for the treatment of angina. Metabolites were stable in urine for at least 6 days at room temperature, approximately 4 degrees C and -20 degrees C.

Biological monitoring of nitroglycerin exposure by urine analysis.

Historically biological monitoring to assess exposure has been difficult due to the rapid half-life of NG. However, the recent development of a method to assess NG and its metabolites (glycerol dinitrates, GDNs) in urine has made biological monitoring more feasible. The data reported here result from samples taken from three sites using NG. Two of the sites are munitions manufacturing sites and the other site is a pharmaceutical manufacturing site. The range of urinary GDN concentrations found in the samples at the two munitions sites were 0.9-18, and 0-4.7 micromol/mol creatinine, and at the pharmaceutical site were 0-0.9 micromol/mol creatinine). The presence of nitroglycols in the urine of workers despite the use of personal protective equipment and local exhaust ventilation shows the usefulness of biological monitoring to assess the efficacy of any controls in place and the potential of dermal absorption of NG.

Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failure.

Supine hypertension, which is very common in patients with autonomic failure, limits the use of pressor agents and induces nighttime natriuresis. In 13 patients with severe orthostatic hypotension due to autonomic failure (7 women, 6 men, 72 +/- 3 yr) and supine hypertension, the effect of 30 mg nifedipine (n = 10) and 0.025 to 0.2 mg/h nitroglycerin patch (n = 11) on supine BP, renal sodium handling, and orthostatic tolerance was determined. Medications were given at 8 p.m.; patients stood up at 8 a.m. Nitroglycerin was removed at 6 a.m. Compared with placebo, nifedipine and nitroglycerin decreased systolic BP during the night by a maximum of 37 +/- 9 and 36 +/- 10 mmHg, respectively (P < 0.01). At 8 a.m., supine systolic BP was 23 +/- 7 mmHg lower with nifedipine than with placebo (P < 0.05), but was similar with nitroglycerin and placebo. Sodium excretion during the night was not reduced with nitroglycerin (0.13 +/- 0.02 mmol/mg creatinine [Cr] versus 0.15 +/- 0.03 mmol/mg Cr with placebo), but it was increased with nifedipine (0.35 +/- 0.06 mmol/mg Cr versus 0.13 +/- 0.02 mmol/mg Cr with placebo, P < 0.05). Nifedipine but not nitroglycerin worsened orthostatic hypotension in the morning. It is concluded that nifedipine and transdermal nitroglycerin are effective in controlling supine hypertension in patients with autonomic failure. However, nifedipine has a prolonged depressor effect and worsens orthostatic hypotension in the morning. The decrease in pressure natriuresis that would be expected with the substantial decrease in BP obtained with nitroglycerin and nifedipine may be offset by a direct effect of both drugs on renal sodium handling.

The effects of hypothermic and normothermic cardiopulmonary bypass on glyceryl trinitrate activity.

Glyceryl trinitrate (GTN) is used to control arterial blood pressure during cardiopulmonary bypass (CPB) procedures, but its effects are often decreased during the period of extracorporeal support. The plasma and urine concentrations of GTN and glyceryl-1,2-dinitrate (1,2-GDN) and glyceryl-1,3-dinitrate (1,3-GDN) for male and female patients who received GTN during hypothermic CPB, and male and female patients who were given GTN during normothermic CPB, were measured by gas-liquid chromatography. During hypothermic CPB, the male and female subjects experienced significant decreases in GTN clearance (P < 0.05), 66% and 52%, respectively. Neither the males nor the females who underwent normothermic CPB experienced any significant change in GTN clearance. These results suggest that the lower core temperature during hypothermic CPB may decrease the biotransformation of GTN to GDNs and nitric oxide, thereby resulting in less dilation of blood vessels. Furthermore, the males in the hypothermic CPB group had significantly greater urinary concentrations of 1,3-GDN and 1,2-GDN than the females (P < 0.05), and the normothermic CPB males had a significantly greater urinary concentration of 1,2-GDN than the females in that group. The normothermic CPB males also had significantly higher plasma concentration of GTN at two time points, and 1,3-GDN at one time point, than the females. These data suggest that there may be a gender difference in GTN biotransformation.

Glyceryl-1-nitrate pharmacokinetics in healthy volunteers.

The plasma kinetics and urinary excretion of glyceryl-1-nitrate (G-1-N), a metabolite of glyceryl trinitrate with antianginal potential, were investigated in 10 healthy male volunteers, after intravenous infusion and oral administration of 20 mg G-1-N. The apparent volume of G-1-N distribution was 601 corresponding to 0.761 kg-1 body weight, on average. It is suggested that total body water is the principal biological correlate of the hydrophilic drug. Mean intravenous clearance was 283 ml min-1 or 3.61 ml min-1 kg-1. The average of elimination half-lives were 2.50 +/- 0.36 (s.d.) h after the intravenous and 2.54 +/- 0.40 (s.d.) h after the oral dose. Inter-subject variances of pharmacokinetic parameters were low compared to variances reported for glyceryl trinitrate. The coefficient of intra-subject variation of the elimination half-lives was 8.8%. 5.5% (i.v.) and 5.4% (p.o.) of the administered dose were excreted into urine up to 48 h after the administration. 1% (i.v.) and 1.5% (p.o.) were in the conjugated form. The oral dose was rapidly and almost completely absorbed. The oral bioavailability on the basis of areas under the curve amounted to 88.6% on the average. For clinical use, owing to its high oral bioavailability, long residence in the body, inactivation by metabolic conversion, and good predictability of kinetic parameters, G-1-N offers advantage over glyceryl trinitrate.

Gas chromatographic assay of glycerol mononitrates in biological samples.

A new gas chromatographic analysis of glycerol 1-nitrate and glycerol 2-nitrate is described. The method is suitable for a variety of biological samples and can detect down to the low nanogram range. An extract of the sample to be analysed is treated with phenylboronic acid. The glycerol mononitrates rapidly form cyclic boronates, with five- and six-membered rings, respectively, which can then be separated by gas chromatography and detected by an electron-capture detector.

Blood levels of the metabolites of glyceryl trinitrate and pentaerythritol tetranitrate after administration of a two-step preparation.

Blood levels and urinary excretion rates of glyceryl trinitrate- pentaerythritol tetranitrate, and their less nitrate containing metabolites have been determined in ten human volunteers after a single dose of a two- step preparation containing glyceryl trinitrate and pentaerythritol tetranitrate. Blood levels accounted for peak levels of about 40% of the glyceryl trinitrate and 0.4% of the pentaerythritol tetranitrate metabolites, respectively. Within the first 24 h post administration 22% of the glyceryl trinitrate and 19% of the pentaerythritol tetranitrate were excreted as nitrate metabolites, chiefly in form of conjugates. The determinations were obtained by gas chromatography on extremely inactive columns and electron capture detection by means of derivatives.