• Adam Schneeweiss
  • Gotthard Schettler
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 72)


Nitrates are agents whose molecule includes the group C-O-NO2. The most widely used nitrates are nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. All nitrates are direct relaxants of vascular smooth muscle and produce coronary and peripheral vasodilation. This is the basis for their therapeutic use in angina pectoris, myocardial infarction, and congestive heart failure. Until the last decade, nitrates were given mainly by the sublingual and oral routes. Recently, nitrates have been administered also intravenously, transdermally, and in the form of oral spray. The newer methods are supposed to improve efficacy and tolerability of nitrates, but their advantages and disadvantages have yet to be determined.


Angina Pectoris Coronary Care Unit Stroke Volume Index Left Ventricular Filling Pressure Isosorbide Dinitrate 
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  1. 1.
    Danahy DT, Aronow WS: Hemodynamic and antianginal effects of high dose oral isosorbide dinitrate after chronic use. Circulation 56:205, 1977.PubMedGoogle Scholar
  2. 2.
    Symanski H: Schwere Gesundheitsschadigungen durch berufliche Nitroglykoleinwirkung. Arch Hyg Bakteriol 136:139, 1952.PubMedGoogle Scholar
  3. 3.
    Distante A, et al: May prolonged high doses of nitrates cause tolerance? Preliminary results on the response to an additional dose by infusion. In: Lichtlen PR, et al (eds) Nitrates III. Springer-Verlag, Berlin, 1981, p 82.Google Scholar
  4. 4.
    Zelis R, Mason DT: Demonstration of nitrate tolerance: attenuation of the vasodilator response to nitroglycerin by the chronic administration of isosorbide dinitrate [abstr]. Circulation [Suppl 3] 40:111–221, 1969.Google Scholar
  5. 5.
    Thadani U, et al: Tolerances to the circulatory effects of oral isosorbide dinitrate: rate of development and cross tolerance to glyceryl trinitrate. Circulation 61:526, 1980.PubMedGoogle Scholar
  6. 6.
    Elbright GE: The effects of nitroglycerin on those engaged in its manufacture. JAMA 62:201, 1914.Google Scholar
  7. 7.
    Stewart D: Tolerance to nitroglycerin. JAMA 44:1678, 1905.Google Scholar
  8. 8.
    Epstein SE, et al: The early phase of acute myocardial infarction: pharmacologic aspects of therapy. Ann Intern Med 78:918, 1973.Google Scholar
  9. 9.
    Antman E, et al: Beneficial effects of intravenous glycerin trinitrate in a case of Prinzmetal’s angina. Br Heart J 43:88, 1980.PubMedCrossRefGoogle Scholar
  10. 10.
    Bauman D: Complications after provocation of coronary spasm with ergonovine maleate [abstr]. Am J Cardiol 42:694, 1978.PubMedCrossRefGoogle Scholar
  11. 11.
    Nelson C: Provocative testing for coronary arterial spasm: rational risk and clinical illustrations. Am J Cardiol 40:624, 1977.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaplan K, et al: Intravenous nitroglycerin for the treatment of angina at rest unresponsive to standard nitrate therapy. Am J Cardiol 51:694, 1983.PubMedCrossRefGoogle Scholar
  13. 13.
    Pepine CJ, et al: Action of intracoronary nitroglycerin in refractory coronary artery spasm. Circulation 65(2):411, 1982.PubMedCrossRefGoogle Scholar
  14. 14.
    Gurfman GD et al: Intravenous nitroglycerin in the treatment of spontaneous angina pectoris: a prospective, randomized trial. Circulation 67:276, 1983.CrossRefGoogle Scholar
  15. 15.
    Lin SG, Flaherty JT: Crossover from intravenous to transdermal nitroglycerin therapy in unstable angina pectoris. Am J Cardiol 56:742, 1985.PubMedCrossRefGoogle Scholar
  16. 16.
    Gold HK, et al: Use of sublingual nitroglycerin in congestive failure following acute myocardial infarction. Circulation 46:839, 1972.PubMedGoogle Scholar
  17. 17.
    Magrini F, Niarchos AP: Ineffectiveness of sublingual nitroglycerin in acute left ventricular failure in the presence of massive peripheral edema. Am J Cardiol 45:841, 1980.PubMedCrossRefGoogle Scholar
  18. 18.
    Strumza P, et al: Prolonged hemodynamic effects (12 hours) of orally administered sustained-release nitroglycerin. Am J Cardiol 43:272, 1979.PubMedCrossRefGoogle Scholar
  19. 19.
    Franciosa JA, et al: Nitrate effects on cardiac output and left ventricular outflow resistance in chronic congestive heart failure. Am J Med 64:207, 1978.PubMedCrossRefGoogle Scholar
  20. 20.
    Rajfer SI, et al: Sustained beneficial hemodynamic responses to large doses of transdermal nitroglycerin in congestive heart failure and comparison with intravenous nitroglycerin. Am J Cardiol 54:120, 1984.PubMedCrossRefGoogle Scholar
  21. 21.
    Figueras J, et al: Comparative haemodynamic and peripheral vasodilator effects of oral and chewable isosorbide dinitrate in patients with refractory congestive cardiac failure. Br Heart J 41:317, 1979.PubMedCrossRefGoogle Scholar
  22. 22.
    Fleisch JH, Hooker CS: The relationship between age and relaxation of vascular smooth muscle in the rabbit and rat. Circ Res 38:243, 1976.PubMedGoogle Scholar
  23. 23.
    Chobanian AV: Pathophysiologic considerations in the treatment of elderly hypertensive patients. Am J Cardiol 52:49D, 1983.Google Scholar
  24. 24.
    Abrams J: The brief saga of transdermal nitroglycerin discs: Paradise lost? Am J Cardiol 54:220, 1984.PubMedCrossRefGoogle Scholar
  25. 25.
    Parker JO: Transdermal nitroglycerin in angina pectoris. Am J Cardiol 54:1984.Google Scholar
  26. 26.
    Sharpe DN, Coxon R: Nitroglycerin in a transdermal therapeutic system in chronic heart failure. J Cardiovasc Pharmacol 6:76, 1984.PubMedCrossRefGoogle Scholar
  27. 27.
    Dickstein K, Knutsen H: A double-blind multiple crossover trial evaluating a transdermal nitroglycerin system vs placebo. Eur Heart J 6:50, 1985.PubMedGoogle Scholar
  28. 28.
    Sullivan M, et al: Failure of transdermal nitroglycerin to improve exercise capacity in patients with angina pectoris. J Am Coll Cardiol 5:1220, 1985.PubMedCrossRefGoogle Scholar
  29. 29.
    Amstrong PW, et al: Blood level after sublingual nitroglycerin. Circulation 59:585, 1979.Google Scholar
  30. 30.
    Kimchi A, et al: Increased exercise tolerance after nitrgolycerin oral spray: a new and effective therapeutic modality in angina pectoris. Circulation 67:124, 1983.PubMedCrossRefGoogle Scholar
  31. 31.
    Winsor T, Berger H: Oral nitroglycerin as a prophylactic antianginal drug: clinical, physiologic, and statistical evidence of efficacy based on a three-phase experimental design. Am Heart J 90:611, 1975.PubMedCrossRefGoogle Scholar
  32. 32.
    Davidov ME, Mroczek WJ: The effect of sustained-release nitroglycerin capsules on angina frequency and exercise capacity. Angiology 28:181, 1977.PubMedCrossRefGoogle Scholar
  33. 33.
    Degré SG, et al: Effect of oral sustained-release nitroglycerin on exercise capacity in angina pectoris: dose-response relation and duration of action during double-blind crossover randomized acute therapy. Am J Cardiol 51:1595, 1983.PubMedCrossRefGoogle Scholar
  34. 34.
    Inhof PR, et al: Plasma concentrations and hemodynamic effects of percutaneously administered nitroglycerin and isosorbide dinitrate in healthy volunteers. In: Lichtlen PR, et al (eds) Nitrates IN. Springer-Verlag, Berlin, 1981, p 66.Google Scholar
  35. 35.
    Needleman P, Johnson EM Jr: Vasodilators and the treatment of angina. In: Goodman-Gilman et al (eds) The pharmacological basis of therapeutics, 6th edn. Macmillan, New York, 1980, p 819.Google Scholar
  36. 36.
    McNiff EF, et al: Nitroglycerin. In: Florey K (ed) Analytical profiles of drug substances, vol 9. Academic Press, Orlando FL, 1980.Google Scholar
  37. 37.
    Taber M, et al: Methemoglobinemia during intravenous nigtoglycerin administration. An abstract presented at the meeting of American Heart Association, 1983.Google Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1987

Authors and Affiliations

  • Adam Schneeweiss
    • 1
  • Gotthard Schettler
    • 2
  1. 1.Geriatric Cardiology Research FoundationTel-AvivIsrael
  2. 2.Department of MedicineUniversity of HeidelbergGermany

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