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Oral nitrate preparations: an update

J W Bomber1, P L De Tullio

  • 1Toledo Hospital, Ohio, USA.

American Family Physician
|December 1, 1995
PubMed
Summary

Oral nitrates effectively treat angina and heart failure. To prevent tolerance, ensure a daily nitrate-free interval with specific dosing schedules for sustained efficacy.

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Area of Science:

  • Pharmacology
  • Cardiovascular Medicine

Background:

  • Oral nitrates are widely prescribed for angina and congestive heart failure.
  • Over 12 million prescriptions were issued in the U.S. in 1993.
  • Available compounds include nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate.

Purpose of the Study:

  • To review the use of oral nitrates in cardiovascular treatment.
  • To address the challenge of nitrate tolerance.
  • To provide strategies for simplified and efficacious nitrate therapy.

Main Methods:

  • Review of existing literature on oral nitrate formulations and administration.
  • Analysis of dosing strategies to circumvent nitrate tolerance.
  • Discussion of various oral nitrate delivery forms (sublingual, translingual, etc.).

Main Results:

  • Nitrate tolerance is a significant challenge in chronic therapy.
  • Efficacious therapy can be maintained by managing tolerance.
  • Specific dosing regimens can prevent tolerance.

Conclusions:

  • Oral nitrate therapy can be simplified and remain effective.
  • Implementing a daily nitrate-free interval is crucial for preventing tolerance.
  • Eccentric, twice-daily dosing or intermittent low dosages are recommended strategies.

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