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Measuring Nitrite and Nitrate, Metabolites in the Nitric Oxide Pathway, in Biological Materials using the Chemiluminescence Method
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Nitrate tolerance. A problem during continuous nitrate administration

J O Parker1

  • 1Department of Medicine, Queen's University, Kingston, Ontario, Canada.

European Journal of Clinical Pharmacology
|January 1, 1990
PubMed

Insights

Organic nitrates effectively manage angina pectoris, but tolerance can reduce their long-term benefits. Strategic nitrate washout periods are crucial for sustained antianginal protection.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Organic nitrates are primary treatments for angina pectoris, effective for acute episodes and prophylaxis.
  • Sustained use of oral and transdermal organic nitrates can lead to tolerance, diminishing antianginal effects over time.

Purpose of the Study:

  • To evaluate the efficacy of organic nitrates in angina management.
  • To investigate the development of nitrate tolerance and strategies to mitigate it.

Main Methods:

  • Review of existing literature on organic nitrate therapy for angina pectoris.
  • Analysis of dosing regimens and their impact on antianginal effects and tolerance.

Main Results:

  • Organic nitrates provide significant short-term antianginal benefits, improving exercise tolerance.
  • Substantial attenuation of therapeutic effects occurs with continuous dosing regimens, indicating nitrate tolerance.
  • Intermittent dosing schedules with nitrate washout periods can prevent or reverse tolerance, maintaining antianginal protection.

Conclusions:

  • Continuous 24-hour antianginal protection with organic nitrates is not achievable due to tolerance.
  • Appropriate dosing schedules, incorporating nitrate washout, are essential to maximize exercise tolerance during the major portion of the dosing period.

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