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Nitrate tolerance--mechanisms and prevention

H Kertland1

  • 1Hartford Hospital, University of Connecticut, School of Pharmacy, Storrs.

Connecticut Medicine
|April 1, 1993
PubMed

Insights

Nitrate tolerance is a clinical issue that reduces medication effectiveness. A nitrate-free interval is the only proven method to maintain nitrate efficacy in patients, guiding optimal nitrate therapy.

Area of Science:

  • Cardiovascular medicine
  • Pharmacology

Background:

  • Nitrate tolerance is a significant clinical problem that diminishes the therapeutic effects of nitrate medications.
  • The precise mechanisms underlying nitrate tolerance are not fully understood but are likely multifactorial.

Purpose of the Study:

  • To review the clinical significance of nitrate tolerance.
  • To discuss potential strategies for preventing or managing nitrate tolerance.
  • To highlight the importance of nitrate-free intervals in maintaining therapeutic efficacy.

Main Methods:

  • Literature review of studies investigating nitrate tolerance.
  • Analysis of clinical trials examining preventative measures for nitrate tolerance.
  • Evaluation of the effectiveness of nitrate-free intervals.

Main Results:

  • Nitrate tolerance significantly impacts patient treatment outcomes.
  • Previous attempts to prevent tolerance with ACE inhibitors, diuretics, and NAC have shown limited success.
  • A nitrate-free interval is the only consistently effective method for preserving nitrate effectiveness.

Conclusions:

  • Avoiding nitrate tolerance is crucial for effective patient management.
  • Further research is needed to define the optimal duration of nitrate-free intervals.
  • Establishing optimal nitrate therapy regimens requires a thorough understanding of tolerance mechanisms and effective management strategies.

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