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British Heart Journal logoLink to British Heart Journal
. 1985 Jun;53(6):631–635. doi: 10.1136/hrt.53.6.631

Efficacy of transdermal glyceryl trinitrate in the treatment of chronic stable angina pectoris.

M A James, P R Walker, M Papouchado, P R Wilkinson
PMCID: PMC481826  PMID: 3924081

Abstract

A study was carried out to assess the efficacy of a new transdermal preparation of glyceryl trinitrate (Transiderm-Nitro 5) in the 24 hour prophylaxis of angina and to determine the duration of effect of a single patch application. Twelve men with chronic stable angina were studied in a randomised, placebo controlled, double blind trial. By serial treadmill exercise testing a therapeutic effect was shown at three hours; the exercise time to angina and to 1 mm ST segment depression and the total exercise time were all significantly increased. At 24, 48, and 72 hours, however, no therapeutic effect was observed. Recent studies have shown a similar lack of effect at 24 hours for various forms of transdermal delivery systems. It is suggested that this lack of effect is due to the rapid onset of tolerance probably as a result of the constancy of blood concentrations obtained by this method of administration.

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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. The brief saga of transdermal nitroglycerin discs: paradise lost? Am J Cardiol. 1984 Jul 1;54(1):220–224. doi: 10.1016/0002-9149(84)90333-3. [DOI] [PubMed] [Google Scholar]
  2. Baxter R. H., Lennox I. M. Increased exercise tolerance with nitrates in beta-blockaded patients with angina. Br Med J. 1977 Aug 27;2(6086):550–552. doi: 10.1136/bmj.2.6086.550. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bogaert M. G., Rosseel M. T., Deschaepdryver A. F. Cardiovascular effects of glyceryldinitrates as compared to glyceryltrinitrate. Arch Int Pharmacodyn Ther. 1968 Dec;176(2):458–460. [PubMed] [Google Scholar]
  4. Cerri B., Grasso F., Cefis M., Pollavini G. Comparative evaluation of the effect of two doses of Nitroderm TTS on exercise-related parameters in patients with angina pectoris. Eur Heart J. 1984 Sep;5(9):710–715. doi: 10.1093/oxfordjournals.eurheartj.a061731. [DOI] [PubMed] [Google Scholar]
  5. GRIZZLE J. E. THE TWO-PERIOD CHANGE-OVER DESIGN AN ITS USE IN CLINICAL TRIALS. Biometrics. 1965 Jun;21:467–480. [PubMed] [Google Scholar]
  6. Lee G., Mason D. T., Amsterdam E. A., Miller R. R., DeMaria A. N. Antianginal efficacy of oral therapy with isosorbide dinitrate capsules. Prolonged benefit shown by exercise testing in patients with ischemic heart disease. Chest. 1978 Mar;73(3):327–332. doi: 10.1378/chest.73.3.327. [DOI] [PubMed] [Google Scholar]
  7. Markis J. E., Gorlin R., Mills R. M., Williams R. A., Schweitzer P., Ransil B. J. Sustained effect of orally administered isosorbide dinitrate on exercise performance of patients with angina pectoris. Am J Cardiol. 1979 Feb;43(2):265–271. doi: 10.1016/s0002-9149(79)80014-4. [DOI] [PubMed] [Google Scholar]
  8. Meister S. G., Engel T. R., Guiha N., Furr C. M., Feitosa G. S., Hart K., Frankl W. S. Sustained haemodynamic action of nitroglycerin ointment. Br Heart J. 1976 Oct;38(10):1031–1036. doi: 10.1136/hrt.38.10.1031. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Müller P., Imhof P. R., Burkart F., Chu L. C., Gérardin A. Human pharmacological studies of a new transdermal system containing nitroglycerin. Eur J Clin Pharmacol. 1982;22(6):473–480. doi: 10.1007/BF00609617. [DOI] [PubMed] [Google Scholar]
  10. Naafs M. A., de Boer A. C., Koster R. W., Klazen C. W., Dunning A. J. Exercise capacity with transdermal nitroglycerin in patients with stable angina pectoris. Eur Heart J. 1984 Sep;5(9):705–709. doi: 10.1093/oxfordjournals.eurheartj.a061730. [DOI] [PubMed] [Google Scholar]
  11. Needleman P., Lang S., Johnson E. M., Jr Organic nitrates: relationship between biotransformation and rational angina pectoris therapy. J Pharmacol Exp Ther. 1972 Jun;181(3):489–497. [PubMed] [Google Scholar]
  12. Packer M., Meller J., Medina N., Yushak M., Gorlin R. Determinants of drug response in severe chronic heart failure. 1. Activation of vasoconstrictor forces during vasodilator therapy. Circulation. 1981 Sep;64(3):506–514. doi: 10.1161/01.cir.64.3.506. [DOI] [PubMed] [Google Scholar]
  13. Parker J. O., Augustine R. J., Burton J. R., West R. O., Armstrong P. W. Effect of nitroglycerin ointment on the clinical and hemodynamic response to exercise. Am J Cardiol. 1976 Aug;38(2):162–166. doi: 10.1016/0002-9149(76)90143-0. [DOI] [PubMed] [Google Scholar]
  14. Parker J. O., Fung H. L., Ruggirello D., Stone J. A. Tolerance to isosorbide dinitrate: rate of development and reversal. Circulation. 1983 Nov;68(5):1074–1080. doi: 10.1161/01.cir.68.5.1074. [DOI] [PubMed] [Google Scholar]
  15. Parker J. O., VanKoughnett K. A., Fung H. L. Transdermal isosorbide dinitrate in angina pectoris: effect of acute and sustained therapy. Am J Cardiol. 1984 Jul 1;54(1):8–13. doi: 10.1016/0002-9149(84)90296-0. [DOI] [PubMed] [Google Scholar]
  16. Reichek N., Goldstein R. E., Redwood D. R., Epstein S. E. Sustained effects of nitroglycerin ointment in patients with angina pectoris. Circulation. 1974 Aug;50(2):348–352. doi: 10.1161/01.cir.50.2.348. [DOI] [PubMed] [Google Scholar]
  17. Reichek N., Priest C., Zimrin D., Chandler T., Sutton M. S. Antianginal effects of nitroglycerin patches. Am J Cardiol. 1984 Jul 1;54(1):1–7. doi: 10.1016/0002-9149(84)90295-9. [DOI] [PubMed] [Google Scholar]
  18. Scheuplein R. J., Blank I. H. Permeability of the skin. Physiol Rev. 1971 Oct;51(4):702–747. doi: 10.1152/physrev.1971.51.4.702. [DOI] [PubMed] [Google Scholar]
  19. Thadani U., Fung H. L., Darke A. C., Parker J. O. Oral isosorbide dinitrate in the treatment of angina pectoris. Dose-response relationship and duration of action during acute therapy. Circulation. 1980 Sep;62(3):491–502. doi: 10.1161/01.cir.62.3.491. [DOI] [PubMed] [Google Scholar]
  20. Thadani U., Manyari D., Parker J. O., Fung H. L. Tolerance to the circulatory effects of oral isosorbide dinitrate. Rate of development and cross-tolerance to glyceryl trinitrate. Circulation. 1980 Mar;61(3):526–535. doi: 10.1161/01.cir.61.3.526. [DOI] [PubMed] [Google Scholar]
  21. Wendt R. L. Systemic and coronary vascular effects of the 2- and the 5-mononitrate esters of isosorbide. J Pharmacol Exp Ther. 1972 Mar;180(3):732–742. [PubMed] [Google Scholar]

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