Use of nitrates in unstable angina pectoris

The rationale for using intravenous nitrates in patients hospitalized with severe angina pectoris is that physiologic action is almost immediate. Many studies and clinical experience indicate that the use of this preparation results in a marked diminution of recurrent angina episodes in most patients. If adverse reactions such as severe hypotension or bradycardia occur, decreasing the dose or stopping it entirely corrects the problem. Intravenous nitroglycerin can be used in combination with other known antianginal agents, such as beta blockers and calcium antagonists. In clinical practice most patients are treated with nitrates and beta blockers or calcium antagonists because the combination of drugs may reduce ischemia and symptoms more than each drug used alone over a long period.