Isosorbide-5-mononitrate--effective monotherapy in chronic stable angina

Area of Science:

• Cardiology
• Pharmacology

Background:

• Isosorbide-5-mononitrate (ISMN) offers predictable blood concentrations due to lack of first-pass metabolism, unlike isosorbide dinitrate.
• Chronic stable angina management requires effective monotherapy with predictable efficacy.

Purpose of the Study:

• To evaluate the efficacy of ISMN as monotherapy in patients with chronic stable angina.
• To determine optimal dosing and therapeutic profile of ISMN.

Main Methods:

• 14 patients with coronary artery disease and exercise-induced angina were enrolled.
• A 2-week placebo period was followed by single-blind ISMN administration with dose titration (20 mg QD, 20 mg BID, 40 mg QD, 40 mg BID).
• Efficacy was assessed via subjective (anginal attacks, GTN use) and objective (treadmill exercise tests at 12h post-dose) measures.

Main Results:

• ISMN significantly increased exercise capacity across all tested dosages.
• A significant reduction in ST depression was observed only with twice-daily (BID) dosing.
• Significant decreases in anginal attack rate and glyceryl trinitrate (GTN) consumption were noted from the 20 mg BID increment.

Conclusions:

• ISMN is an effective antianginal agent, particularly with a twice-daily dosage regimen.
• While 20 mg and 40 mg BID showed similar efficacy, individual patient variability suggests the need for flexible dosing.
• Twice-daily ISMN provides a favorable therapeutic profile for managing chronic stable angina.