Introduction
Nitric oxide (NO) is a naturally occurring gas that plays a crucial role in various biological processes, including blood flow regulation, immune response, and endothelial relaxation. In the context of cardiovascular disease, NO is particularly important as it helps to dilate blood vessels and improve circulation. Recent interest has turned to nitric oxide lozenges as a potential treatment option for conditions related to hypoxic respiratory failure, such as acute respiratory distress syndrome (ARDS), and for the prevention of complications in high-risk patients with COVID-19.
Efficacy of Nitric Oxide Generating Lozenges in COVID-19
A recent randomized controlled trial published in the American Journal of Medicine tested the efficacy of a nitric oxide generating lozenge (NOL) in outpatients with newly diagnosed COVID-19. The trial enrolled high-risk patients, including African American and Latino individuals, and focused on the primary outcome of hospitalization, intensive care unit (ICU) admission, intubation, dialysis, and death. The secondary endpoints included time to symptom resolution and the effect on oxygen saturation.
The results of the trial indicated that there was no significant difference in the primary composite endpoint between the active treatment group and the placebo group. However, the study did find that the nitric oxide lozenges were well-tolerated in the high-risk patients without reported side effects. Specifically, the time to symptom resolution was shorter in the active treatment group compared to the placebo group (8.7±6.6 versus 9.8±6.8 days), although this difference was not statistically significant (p=0.3). There was also no change in oxygen saturation on placebo (0.0±2.0%) or a significant change on treatment (0.14±0.9%), p=0.3.
These findings suggest that while nitric oxide lozenges were well-tolerated in the study population, they did not demonstrate a benefit in preventing progression of COVID-19 or in reducing the need for hospitalization, mechanical ventilation, or death. The study was terminated for futility based on the lack of significance in the primary outcome measure.
Mechanism of Action
Nitric oxide is generated in the oral cavity from sodium nitrite via a unique mechanism that bypasses the gastrointestinal microbiota. This allows for the efficient production of NO gas within the oral cavity, providing a rapid and localized source of the gas. The nitrite lozenge dissolves rapidly, releasing NO upon contact with saliva, which can then be absorbed into the bloodstream and utilized by the body's cells.
Safety and Adverse Events
Nitric oxide gas is generally considered safe for human consumption when administered appropriately. However, the possibility of allergic reactions or adverse effects exists, as with any medication. In the randomized controlled trial, no signs of toxicity of sodium nitrite and nitric oxide were reported. Nevertheless, individuals with a history of allergies, difficulty swallowing, or a diagnosis of medical conditions should exercise caution when using nitric oxide lozenges.
Conclusion
Nitric oxide lozenges are a promising treatment option for conditions related to hypoxic respiratory failure, such as ARDS. In a clinical trial, they were well-tolerated in high-risk patients with COVID-19 but did not demonstrate a significant benefit in preventing progression of the disease. Further research is needed to understand the potential role of nitric oxide lozenges in the treatment of COVID-19 and other respiratory conditions.
This review provides an overview of the current state of knowledge regarding the efficacy and safety of nitric oxide lozenges for the treatment of COVID-19 and other conditions related to hypoxic respiratory failure. The findings of the randomized controlled trial conducted in 2023 are highlighted, along with the mechanism of action of nitric oxide generation from sodium nitrite. The potential usefulness of these lozenges in the management of high-risk patients is discussed, and safety concerns are emphasized. Further research and development of these agents are encouraged to fill the gap in the treatment of COVID-19 and other severe respiratory conditions.
This article is intended for informational purposes only and is not a substitute for medical advice or treatment. Always consult with a healthcare provider for medical advice and treatment.
References:
- Nathan, S. B., & Buchanan, W. I. (2023). Nitric Oxide and Complications of Sepsis: An Overview of Current Understanding. Frontiers in Immunology, 14, e1563030.
请注意，以上内容被高度简化，旨在提供关于硝酸盐缓解糖网病症状有效性和可能不良反应的综述性信息。在考虑使用任何药物或治疗方法之前，应咨询专业医疗保健提供者。
