Long-acting nitrates: relative utility of nitroglycerin patches

Cutaneous nitroglycerin patches offer an attractive, convenient approach to antianginal prophylaxis with nitroglycerin. Blood level data have suggested that nitroglycerin patches could have antianginal effects for 24 hours or more. However, direct documentation of antianginal efficacy is fragmentary at present. Existing studies using provocative exercise testing, with one exception, do not demonstrate antianginal effects of nitroglycerin patches at 24 hours, using either low or maximal tolerated doses in each subject. Furthermore, in contrast to other long-acting nitrates evaluated in similar fashion, the peak effects of nitroglycerin patches may not be as potent as those of sublingual nitroglycerin. Thus, at present, clinicians should not assume that nitroglycerin patches can provide 24-hour prophylaxis. Further, in patients on a patch regimen with continuing symptoms, consideration should be given to a trial of alternative or additional long-acting nitrates of other types.