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Related Experiment Videos

Nitrate tolerance. How to prevent it or minimize its effect.

U Thadani1

  • 1Cardiology Section, University of Oklahoma Health Sciences Center, Oklahoma City 73104.

Postgraduate Medicine
|April 1, 1992
PubMed
Summary

Nitrate tolerance diminishes antianginal effects. Intermittent nitrate use or combination therapy can prevent tolerance in stable angina. Continuous intravenous nitroglycerin is used for unstable angina.

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Continuous nitrate therapy leads to rapid tolerance, reducing circulatory, antianginal, and anti-ischemic effects.
  • Nitrate tolerance is a significant clinical challenge in managing angina and heart failure.

Purpose of the Study:

  • To review strategies for avoiding or managing nitrate tolerance.
  • To outline appropriate nitrate use in stable angina, unstable angina, and congestive heart failure.

Main Methods:

  • Review of existing literature on nitrate therapy and tolerance.
  • Analysis of different dosing regimens and combination therapies for angina management.

Main Results:

  • Intermittent nitrate use with nitrate-free intervals is effective for stable angina.
  • Transdermal nitroglycerin or specific oral nitrate regimens can mitigate tolerance.
  • Intravenous nitroglycerin is recommended for acute unstable angina.
  • Oral isosorbide dinitrate plus hydralazine may benefit heart failure patients with ACE inhibitor intolerance.

Conclusions:

  • Nitrate tolerance can be effectively managed through strategic dosing and combination therapies.
  • Specific approaches are recommended for stable angina, unstable angina, and heart failure.
  • Concomitant use of sulfhydryl donors or ACE inhibitors to prevent tolerance is not currently recommended due to conflicting data and potential adverse effects.

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