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Mononitrates: defining the ideal long-acting nitrate
W H Frishman1, E Amsterdam, S P Glasser
1Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
Clinical Therapeutics
|March 1, 1994
Summary
Nitrates, converted to nitric oxide, treat myocardial ischemia by improving oxygen supply. New isosorbide-5-mononitrate formulations offer options for chronic stable angina, though formulation differences warrant further study.
Area of Science:
- Cardiovascular Pharmacology
- Vascular Biology
Background:
- Nitric oxide (NO) and endothelial-derived relaxing factor (EDRF) are crucial for vascular control.
- Dysfunction in EDRF signaling contributes to myocardial ischemia.
- Nitrates offer a therapeutic strategy by replenishing NO.
Purpose of the Study:
- To review the renewed interest in nitrates for ischemic syndromes.
- To introduce new formulations of isosorbide-5-mononitrate.
- To highlight potential differences between mononitrate formulations.
Main Methods:
- Literature review on nitric oxide, EDRF, and nitrates.
- Overview of recently available isosorbide-5-mononitrate formulations in the US.
- Discussion of the implications of formulation variations.
Main Results:
- Nitrates, through conversion to nitric oxide, induce vasodilation.
- This vasodilation improves the myocardial oxygen supply-demand balance, alleviating ischemia.
- Three distinct isosorbide-5-mononitrate formulations (Ismo, Monoket, Imdur) have been introduced since 1992.
Conclusions:
- Isosorbide-5-mononitrate represents a significant advancement in nitrate therapy.
- Despite sharing a generic name, available mononitrate formulations differ.
- Further research is needed to elucidate clinical distinctions between these formulations for optimal patient care.