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Nitrate tolerance.

J O Parker1

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

The American Journal of Cardiology
|November 16, 1987
PubMed
Summary

Nitrate tolerance significantly reduces the effectiveness of organic nitrates for angina pectoris. Intermittent nitrate administration, particularly oral nitrates given 2-3 times daily, can overcome this tolerance.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Organic nitrates are primary agents for managing angina pectoris.
  • Initial oral nitrate administration yields significant hemodynamic and exercise improvements.
  • Tolerance to nitrate effects develops rapidly with regular administration.

Purpose of the Study:

  • To investigate the development and implications of nitrate tolerance in angina management.
  • To evaluate the efficacy of different nitrate administration schedules.
  • To determine strategies for overcoming nitrate tolerance.

Main Methods:

  • Review of studies on oral and transdermal organic nitrate administration.
  • Analysis of hemodynamic, anti-ischemic, and antianginal effects over time.
  • Comparison of continuous versus intermittent nitrate therapy schedules.

Main Results:

  • Regular oral nitrate therapy significantly reduces hemodynamic and antianginal effects.
  • Transdermal nitrates show diminished efficacy with sustained daily use, approaching placebo effects.
  • Nitrate tolerance is reversible during nitrate-free periods.

Conclusions:

  • Nitrate tolerance is a clinically significant issue in angina treatment.
  • Intermittent oral nitrate administration (2-3 times daily) preserves antianginal effects.
  • Further research is needed on intermittent transdermal nitrate administration schedules.

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