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A Comparison of Isosorbide-5-Mononitrate and Transdermal Glyceryl Trinitrate: Acute Effects and Tolerance Development During Chronic Therapy

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Mononitrate II

Part of the book series: International Boehringer Mannheim Symposia ((BOEHRINGER))

Abstract

Isosorbide-5-Mononitrate (IS-5-MN), the main metabolite on denitration of isosorbide dinitrate (ISDN) [4, 5], has gained an established place in the long-term treatment of coronary heart disease [22, 42, 44]. In the steady state, the antiangial action of 20 mg IS-5-MN lasts for 10.5 h [25]. Glyceryl trinitrate (NTG), which has been used since 1879 for antianginal therapy [26], exerts its hemodynamic effects within 60–90 s when administered buccally or sublingually. A long-lasting action of NTG on oral administration is doubtful because of the high hepatic metabolic inactivation rate (fist-pass effect) [9, 23, 27, 39]. It has been shown that transdermal administration of NTG produces constant plasma levels [18, 24, 31], but investigations of the clinical efficacy of transdermal administration of NTG give contradictory results. We compared the antianginal action of oral IS-5-MN and transdermal NTG on acute administration and following long-term therapy. The aim of this study was to investigate the possible development of tolerance to these two forms of antianginal therapy.

A randomized double-blind cross-over study

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Authors
  1. W. Sehnert
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Editors and Affiliations

  1. British Heart Foundation, 102 Gloucester Place, London, W1H 4DH, UK

    D. G. Julian Prof. M.D. (Medical Director) (Medical Director)

  2. Clinical Research Boehringer Mannheim GmbH, Sandhofer Straße 116, 6800, Mannheim 31, Federal Republic of Germany

    R. Rittinghausen M.D. (Director) (Director)

  3. Cardiovascular Clinical Research Boehringer Mannheim GmbH, Sandhofer Straße 116, 6800, Mannheim 31, Federal Republic of Germany

    H. J. Überbacher M.D.

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Sehnert, W. (1987). A Comparison of Isosorbide-5-Mononitrate and Transdermal Glyceryl Trinitrate: Acute Effects and Tolerance Development During Chronic Therapy. In: Julian, D.G., Rittinghausen, R., Überbacher, H.J. (eds) Mononitrate II. International Boehringer Mannheim Symposia. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-72689-7_10

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  • DOI: https://doi.org/10.1007/978-3-642-72689-7_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-17832-3

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