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Transdermal nitroglycerin in angina pectoris.

J Abrams1

  • 1Division of Cardiology, University of New Mexico School of Medicine, Albuquerque.

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|May 1, 1989
PubMed
Summary
This summary is machine-generated.

Transdermal nitroglycerin patches are effective for angina but can cause nitrate tolerance. An intermittent dosing schedule, removing patches for 10-12 hours daily, effectively prevents tolerance.

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Transdermal nitroglycerin patches, introduced in 1982, are widely used nitrate formulations for angina pectoris.
  • Despite their success, significant controversy exists regarding their efficacy and the development of nitrate tolerance.
  • Nitroglycerin exhibits multiple mechanisms of action in managing angina.

Purpose of the Study:

  • To evaluate the efficacy of transdermal nitroglycerin patches in angina patients.
  • To investigate the phenomenon of nitrate tolerance associated with these patches.
  • To determine optimal dosing strategies to mitigate nitrate tolerance.

Main Methods:

  • Review of existing data on transdermal nitroglycerin formulations (patches and ointments).
  • Analysis of dose-dependent effects of nitroglycerin patches (≥10 mg/24h).
  • Examination of acute and chronic dosing effects on efficacy and tolerance.

Main Results:

  • Transdermal nitroglycerin patches provide classic nitrate effects in angina patients at doses ≥10 mg/24h.
  • Nitrate tolerance significantly diminishes patch efficacy within 24 hours of acute dosing and with chronic use.
  • Intermittent patch application (12-14 hours on, 10-12 hours off) appears to be the most effective strategy.

Conclusions:

  • Nitrate tolerance is a significant issue with continuous transdermal nitroglycerin use.
  • An intermittent or interval dosing approach is recommended to maintain therapeutic efficacy.
  • This strategy markedly reduces or eliminates nitrate tolerance, improving angina management.