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. 1992;34(Suppl 1):19S–23S. doi: 10.1111/j.1365-2125.1992.tb04144.x

Prophylactic nitrate therapy in angina pectoris - is there an optimal treatment regimen?

G Olsson, J Allgén
PMCID: PMC1381218  PMID: 1633074

Abstract

1 Nitrates have a place in the prophylactic treatment of patients with angina pectoris. Their efficacy is not in doubt.

2 However, there may be some practical problems associated with their use, such as unreliable absorption, short duration of action, treatment-induced headache, development of nitrate tolerance and a suggested rebound phenomenon observed during intermittent dosing. Furthermore, patient convenience with treatment schedule and patient compliance have to be considered during prophylactic treatment. The present article discusses how many of these problems may be solved by selection of formulation as well as nitrate compound.

3 The development of controlled-release formulations producing sufficiently high nitrate plasma concentration during part of the day followed by nitrate-poor rather than nitrate-free interval, have the potential to prevent both nitrate tolerance and rebound phenomenon, and produce a sufficiently long duration of action with a convenient once-daily regimen.

Keywords: ischaemic heart disease, nitrates, nitrate tolerance

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abrams J. New nitrate delivery systems: buccal nitroglycerin. Am Heart J. 1983 May;105(5):848–854. doi: 10.1016/0002-8703(83)90251-x. [DOI] [PubMed] [Google Scholar]
  2. Cowan C., Bourke J., Reid D. S., Julian D. G. Tolerance to glyceryl trinitrate patches: prevention by intermittent dosing. Br Med J (Clin Res Ed) 1987 Feb 28;294(6571):544–545. doi: 10.1136/bmj.294.6571.544-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. DeMots H., Glasser S. P. Intermittent transdermal nitroglycerin therapy in the treatment of chronic stable angina. J Am Coll Cardiol. 1989 Mar 15;13(4):786–795. doi: 10.1016/0735-1097(89)90216-7. [DOI] [PubMed] [Google Scholar]
  4. Ferratini M., Pirelli S., Merlini P., Silva P., Pollavini G. Intermittent transdermal nitroglycerin monotherapy in stable exercise-induced angina: a comparison with a continuous schedule. Eur Heart J. 1989 Nov;10(11):998–1002. doi: 10.1093/oxfordjournals.eurheartj.a059425. [DOI] [PubMed] [Google Scholar]
  5. Jonsson U. E. Development of long-acting nitrate delivery systems. Eur J Clin Pharmacol. 1990;38 (Suppl 1):S15–S19. doi: 10.1007/BF01417560. [DOI] [PubMed] [Google Scholar]
  6. Kampmann J. P. Pharmacokinetics of various preparations of organic nitrates. Drugs. 1987;33 (Suppl 4):5–8. doi: 10.2165/00003495-198700334-00004. [DOI] [PubMed] [Google Scholar]
  7. Kendall M. J. Long-term therapeutic efficacy with once-daily isosorbide-5-mononitrate (Imdur). J Clin Pharm Ther. 1990 Jun;15(3):169–185. doi: 10.1111/j.1365-2710.1990.tb00373.x. [DOI] [PubMed] [Google Scholar]
  8. Meffert M., Paeckelmann I. M. Experience of long term treatment and different dosage regimens of isosorbide 5-mononitrate. Drugs. 1987;33 (Suppl 4):104–110. doi: 10.2165/00003495-198700334-00019. [DOI] [PubMed] [Google Scholar]
  9. Nyberg G., Carlens P., Lindström E., Lundman T., Nordlander R., Rehnqvist N., Ulvenstam G., Aberg A., Aström H. The effect of isosorbide-5-mononitrate (5-ISMN) Durules on exercise tolerance in patients with exertional angina pectoris. A placebo controlled study. Eur Heart J. 1986 Oct;7(10):835–842. doi: 10.1093/oxfordjournals.eurheartj.a061969. [DOI] [PubMed] [Google Scholar]
  10. Parker J. O., Farrell B., Lahey K. A., Moe G. Effect of intervals between doses on the development of tolerance to isosorbide dinitrate. N Engl J Med. 1987 Jun 4;316(23):1440–1444. doi: 10.1056/NEJM198706043162303. [DOI] [PubMed] [Google Scholar]
  11. Parker J. O., Fung H. L. Transdermal nitroglycerin in angina pectoris. Am J Cardiol. 1984 Sep 1;54(6):471–476. doi: 10.1016/0002-9149(84)90233-9. [DOI] [PubMed] [Google Scholar]
  12. Rehnqvist N., Olsson G., Engvall J., Rosenqvist U., Nyberg G., Aberg A., Ulvenstam G., Uusitalo A., Keyriläinen O., Reinikainen P. Abrupt withdrawal of isosorbide-5-mononitrate in Durules (Imdur) after long term treatment in patients with stable angina pectoris. Eur Heart J. 1988 Dec;9(12):1339–1347. doi: 10.1093/oxfordjournals.eurheartj.a062452. [DOI] [PubMed] [Google Scholar]
  13. Thadani U., Fung H. L., Darke A. C., Parker J. O. Oral isosorbide dinitrate in angina pectoris: comparison of duration of action an dose-response relation during acute and sustained therapy. Am J Cardiol. 1982 Feb 1;49(2):411–419. doi: 10.1016/0002-9149(82)90518-5. [DOI] [PubMed] [Google Scholar]
  14. Uusitalo A., Keyriläinen O., Härkönen R., Rautio P., Rehnqvist N., Engvall J., Rosenqvist U., Nyberg G., Aberg A., Ulvenstam G. Anti-anginal efficacy of a controlled-release formulation of isosorbide-5-mononitrate once daily in angina patients on chronic beta-blockade. Acta Med Scand. 1988;223(3):219–225. doi: 10.1111/j.0954-6820.1988.tb15790.x. [DOI] [PubMed] [Google Scholar]
  15. Uusitalo A. Long term efficacy of a controlled-release formulation of isosorbide 5-mononitrate (Imdur) in angina patients receiving beta-blockers. Drugs. 1987;33 (Suppl 4):111–117. doi: 10.2165/00003495-198700334-00020. [DOI] [PubMed] [Google Scholar]
  16. Wagner F., Siefert F., Trenk D., Jähnchen E. Relationship between pharmacokinetics and hemodynamic tolerance to isosorbide-5-mononitrate. Eur J Clin Pharmacol. 1990;38 (Suppl 1):S53–S59. doi: 10.1007/BF01417565. [DOI] [PubMed] [Google Scholar]
  17. Wisenberg G., Roks C., Nichol P., Goddard M. D. Sustained effect of and lack of development of tolerance to controlled-release isosorbide-5-mononitrate in chronic stable angina pectoris. Am J Cardiol. 1989 Sep 15;64(10):569–576. doi: 10.1016/0002-9149(89)90480-3. [DOI] [PubMed] [Google Scholar]

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