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Controlled release isosorbide-5-mononitrate in angina pectoris: a comparison with standard formulation isosorbide
1Division of Cardiology, Queen's University, Kingston, Ontario.
The Canadian Journal of Cardiology
|April 1, 1991
Summary
Isosorbide-5-mononitrate (ISMN) demonstrated sustained anti-ischemic effects, improving exercise tolerance without tolerance development. Isosorbide dinitrate (ISDN) showed acute benefits but lost efficacy with sustained therapy.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Angina pectoris and myocardial ischemia are significant cardiovascular conditions.
- Nitrate formulations are commonly used for managing ischemic heart disease.
Purpose of the Study:
- To compare the antianginal and anti-ischemic effects of controlled-release isosorbide-5-mononitrate (ISMN) and standard isosorbide dinitrate (ISDN).
- To assess the development of tolerance during sustained therapy with these nitrate formulations.
Main Methods:
- A randomized, double-blind, placebo-controlled, crossover study design was employed.
- Participants received ISMN 60 mg once daily or ISDN 30 mg four times daily.
- Exercise tolerance was measured using treadmill walking time during acute and sustained (7-day) therapy.
Main Results:
- Acute ISMN and ISDN administration improved exercise tolerance compared to placebo.
- Sustained ISDN therapy resulted in no significant improvement over placebo, indicating tolerance.
- ISMN showed no significant difference between acute and sustained therapy, suggesting a lack of tolerance.
- Exercise tolerance was significantly greater with ISMN compared to ISDN during sustained therapy.
Conclusions:
- Controlled-release ISMN offers sustained anti-ischemic benefits without significant tolerance development.
- Standard ISDN therapy leads to a loss of efficacy with repeated dosing.
- ISMN may be a more effective long-term treatment option for patients with angina and ischemia.
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