Nitrate Therapy in Angina Pectoris

  • Adam Schneeweiss

Abstract

Several investigators have suggested that long-term treatment with nitrates in patients with angina pectoris is associated with the development of tolerance. Although this theory is in contrast to the clinical experience of most cardiologists, it is supported by evidence from controlled trials, reported by Parker, Rudolph, Thadani and their coworkers. In this chapter the subject is reviewed, with the conclusion that tolerance to the antianginal effect can be reduced if the drugs are appropriately used. The topic is subdivided into three main areas:
  1. 1.

    Vascular tolerance

     
  2. 2.

    Tolerance to the antianginal effect

     
  3. 3.

    Cross tolerance

     

Keywords

Glycerin Depression Attenuation Cysteine Radionuclide 

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References

  1. 1.
    Zelis R, Mason DT (1975) Isosorbide effect on the vasodilator response to nitroglycerin. JAMA 234: 166–170PubMedCrossRefGoogle Scholar
  2. 2.
    Parker JO, Fung H-L, Ruggirello BS, Stone JA (1983) Tolerance to isosorbide dinitrate: rate of development and reversal. Circulation 68: 1074–1080PubMedCrossRefGoogle Scholar
  3. 3.
    Stewart DJ, Eisner D, Sommer O, Holtz J, Bassenge E (1986) Altered spectrum of nitroglycerin action in long-term treatment: nitroglycerinspecific venous tolerance with maintenance of arterial vasodepressor potency. Circulation 74: 573–582PubMedCrossRefGoogle Scholar
  4. 4.
    Manyari DE, Smith ER, Spragg J (1985) Isosorbide dinitrate and glyceryl trinitrate: demonstration of cross tolerance in the capacitance vessels. Am J Cardiol 55: 927–931PubMedCrossRefGoogle Scholar
  5. 5.
    Bennett D, Barclay SA, Adam J, Valentine H, Boyle GJ (1987) Transdermal nitroglycerin causes plasma volume expansion which may explain tolerance to transdermal nitroglycerin. Eur Heart J 8[Suppl 1]: 18Google Scholar
  6. 6.
    Wortmann A, Bachmann K, Deuber HJ, Roth E (1986) Hämodynamik und Koronardynamik unter ISDN-Langzeittherapie. Z Kardiol 75[Suppl 3]: 68–76PubMedGoogle Scholar
  7. 7.
    Distante A, Lombardi M, Morales MA, Moscarelli E, L’Abbate A (1985) Preserved hemodynamic response to acute dose of ISDN in anginal patients chronically treated with the same drug percutaneously (Abstract). Eur Heart J 5[Suppl 1]: 269Google Scholar
  8. 8.
    Kukovetz WR, Holzmann S, Romanin C (1987) Mechanism of vasodilation by nitrates: role of cyclic GMP. Cardiology 74[Suppl 1]: 12–19PubMedCrossRefGoogle Scholar
  9. 9.
    Thadani U, Manyari D, Parker JO, Fung H-L (1980) Tolerance to the circulatory effects of oral isosorbide dinitrate. Rate of development and cross-tolerance to glyceryl trinitrate. Circulation 61: 526–535PubMedGoogle Scholar
  10. 10.
    Danahy DT, Aronow WS (1977) Hemodynamic and antianginal effects of high-dose oral isosorbide after chronic use. Circulation 56: 205–212PubMedGoogle Scholar
  11. 11.
    Niederer W, Bethge HD, Bachmann K (1983) Hemodynamic and ventricular dynamic investigations of nitrate tolerance. In: Kaltenbach M, Kober G (eds) Nitrates and nitrate tolerance in angina pectoris. Steinkopff, Darmstadt, pp 65–74CrossRefGoogle Scholar
  12. 12.
    Schneider WU, Bussmann WD, Stahl B, Kaltenbach M (1984) Doseresponse relation of antianginal activity of isosorbide dinitrate. Am J Cardiol 53: 700–705PubMedCrossRefGoogle Scholar
  13. 13.
    Nyberg G, Nilsson B (1985) Antianginal efficacy of isosorbide-5-mononitrate in a controlled-release (durules) formulation. Br J Clin Pharmacol 20: 504PGoogle Scholar
  14. 14.
    Ohlmeier H, Mertens HM, Mannebach H, Gleichman U (1985) Tolerance and rebound phenomena in nitrate therapy. In: Cohn JN, Rittinghausen R (eds) Mononitrates. Springer, Berlin Heidelberg New York, pp 107–123CrossRefGoogle Scholar
  15. 15.
    Rennhak U, Riebesel T, Biamino G (1985) A double-blind cross-over study on the effectiveness and possible development of tolerance during long-term therapy with isosorbide-5-mononitrate or isosorbide dinitrate slow-release in coronary artery disease. In: Cohn JN, Rittinghausen R (eds) Mononitrates. Springer, Berlin Heidelberg New York, pp 147–153CrossRefGoogle Scholar
  16. 16.
    Dalai JJ, Yao L, Parker JO (1983) Nitrate tolerance: influence of isosorbide dinitrate on the hemodynamic and antianginal effects of nitroglycerin. J Am Coll Cardiol 2: 115–120CrossRefGoogle Scholar
  17. 17.
    Parker JO, VanKoughnett KA, Fung H-L (1984) Transdermal isosorbide dinitrate in angina pectoris: effect of acute and sustained therapy. Am J Cardiol 54: 8–13PubMedCrossRefGoogle Scholar
  18. 18.
    Parker JO, Fung H-L (1984) Transdermal nitroglycerin in angina pectoris. Am J Cardiol 54: 471–476PubMedCrossRefGoogle Scholar
  19. 19.
    Kaltenbach M, Schneider W (1986) Continuing antianginal action during chronic nitrate treatment despite cessation of hemodynamic effects. Dtsch Med Wochenschr 111: 383–386PubMedCrossRefGoogle Scholar
  20. 20.
    Blasini R, Reiniger G, Brügmann U (1985) Tolerance to the antiischemic effect of isosorbide dinitrate during continuous but not during intermittent oral therapy. In: Cohn JH, Rittinghausen R (eds) Mononitrates. Springer, Berlin Heidelberg New York, pp 124–129CrossRefGoogle Scholar
  21. 21.
    Silber S, Krause KH, Garner G, Theisen K, Jahrmarker H (1983) Anti-ischemic effects of an 80 mg tablet of isosorbide dinitrate in sustained-release form before and after 2 weeks of treatment with 80 mg once daily or twice daily. K Kardiol 72[Suppl 3]: 211–217Google Scholar
  22. 22.
    Boertz A, Bonn R (1986) Nitrates therapy without loss of action by correct dosage. Z Kardiol 7[Suppl 3]: 57–69Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • Adam Schneeweiss
    • 1
  1. 1.Tel AvivIsrael

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