Nitrate tolerance

These studies have shown the following: Tolerance to the hemodynamic and antianginal effects of isosorbide dinitrate. Tolerance develops quickly and can be demonstrated within 24 hours. Tolerance is rapidly reversed and the return of normal responsiveness is seen within 21 hours withdrawal of isosorbide dinitrate. Cross-tolerance occurs between the hemodynamic effects of isosorbide dinitrate and nitroglycerin. When tolerance is present, the next dose of isosorbide dinitrate does exert an effect, although somewhat less in magnitude and duration. Sublingual isosorbide dinitrate and nitroglycerin restores exercise performance despite tolerance to oral isosorbide dinitrate.