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Effectiveness of interval nitrate therapy in angina pectoris
W Rudolph1, J Dirschinger, D Hall
1Department of Cardiology, German Heart Center, Munich, F.R.G.
European Heart Journal
|May 1, 1989
Summary
Interval treatment is crucial for effective long-term nitrate therapy, preventing tolerance. This dosing strategy ensures sustained antianginal and anti-ischaemic effects by managing nitrate plasma concentrations.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
Background:
- Rapid tolerance development limits the efficacy of frequent oral nitrate doses and continuous transdermal nitrate application.
- Nitrate accumulation in plasma necessitates specific dosing to maintain therapeutic effects.
Purpose of the Study:
- To evaluate the effectiveness of interval treatment for long-term nitrate therapy.
- To explore methods for preventing nitrate tolerance and optimizing antianginal effects.
Main Methods:
- Review of controlled studies documenting interval treatment dosing regimens for oral nitrates (isosorbide dinitrate, isosorbide 5-mononitrate) and transdermal nitroglycerin.
- Analysis of strategies for discontinuous release from transdermal patches.
- Examination of recent findings on preventing nitroglycerin tolerance by gradual plasma concentration increase.
Main Results:
- Interval treatment effectively utilizes nitrates' antianginal and anti-ischaemic effects for long-term management.
- Specific interval dosing regimens for various nitrate formulations have been established.
- Gradual plasma concentration increase in transdermal nitroglycerin can prevent early tolerance development.
Conclusions:
- Interval treatment is the justified approach for long-term nitrate therapy, overcoming rapid tolerance.
- Established interval dosing regimens ensure maintained effectiveness of nitrates.
- No clinically relevant rebound phenomena were observed during interval treatment.
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