Transdermal Nitroglycerin and Nitrate Tolerance

Editorials1 March 1986Transdermal Nitroglycerin and Nitrate ToleranceJONATHAN ABRAMS, M.D.JONATHAN ABRAMS, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-104-3-424 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptConsiderable recent data suggest that the use of transdermal nitroglycerin disks may be associated with the rapid development of nitrate tolerance. Studies in patients with angina pectoris (1-4) and congestive heart failure (5-8) have indicated that the use of this nitrate formulation, which releases drug continuously for at least 24 hours, is associated with loss of clinical and hemodynamic effects of nitroglycerin within 18 to 24 hours after initial (acute) dosing. Although these surprising observations have engendered controversy (9, 10), it seems clear that nitrate tolerance is the likeliest explanation for the similar findings shown in various investigations (1-8).In...References1. REICHEK N, PRIEST C, ZIMRIN D, CHANDLER T, and SUTTON M. Antianginal effects of nitroglycerin patches. Am J Cardiol. 1984;54:1-7. CrossrefMedlineGoogle Scholar2. PARKER J and FUNG H. Transdermal nitroglycerin in angina pectoris. Am J Cardiol. 1984;54:471-6. CrossrefMedlineGoogle Scholar3. THADANI U, BRADY C, and KLUTTS S. Dose titration and duration of effects of transdermal nitroglycerin patches in angina pectoris [Abstract]. Circulation. 1985;72(4 pt 2):III-431. Google Scholar4. JAMES M, WALKER P, PAPOUCHADO M, and WILKINSON P. Efficacy of transdermal glyceryl trinitrate in the treatment of chronic stable angina pectoris. Br Heart J. 1985;53:631-5. CrossrefMedlineGoogle Scholar5. OLIVARI M, CARLYLE P, LEVINE T, and COHN J. 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Transdermal isosorbide dinitrate in angina pectoris: effect of acute and sustained therapy. Am J Cardiol. 1984;54:8-13. CrossrefMedlineGoogle Scholar20. ABRAMS J. New nitrate delivery systems: relationship to nitrate tolerance. N Engl J Med. 1986. (In press). Google Scholar21. PARKER J, FUNG H, RUGGIRELLO D, and STONE J. Tolerance to isosorbide dinitrate: rate of development and reversal. Circulation. 1983;68:1074-84. CrossrefMedlineGoogle Scholar22. REINIGER G, BLASINI R, BRUGMANN U, and RUDOLPH W. Nitroglycerin patches in coronary artery disease: can tolerance development be avoided through interval therapy [Abstract]? Circulation. 1985;72(4 pt 2): III-431. Google Scholar23. MAGRINI F and NIARCHOS A. Ineffectiveness of sublingual nitroglycerin in acute left ventricular failure in the presence of massive peripheral edema. Am J Cardiol. 1980;45:841-7. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: JONATHAN ABRAMS, M.D.Affiliations: University of New Mexico School of Medicine Albuquerque, New Mexico PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTransdermal nitroglycerin reduces the frequency of anginal attacks but fails to prevent silent ischemiaAngina PectorisLong-term efficacy of continuous and intermittent use of transdermal nitroglycerin in stable angina pectorisEvidence for or Against Clinical Efficacy of Preload ReducersHemodynamic effects of nitroglycerin in an experimental model of acute aortic regurgitationRandomized clinical trials of transdermal nitroglycerin systems for the treatment of angina: A meta-analysisInterdependence of pharmacologically-induced and endothelium-mediated coronary vasodilation in antianginal therapyThe Cardiovascular SystemTolerance to Organic Nitrates in Ischemic Heart DiseaseAn Acute Double-Blind Placebo-Controlled Study of Transdermal Glyceryl Trinitrate with 12 Months' Follow-up in Patients with Stable Angina PectorisNitrate therapy of ischaemic heart diseaseLong-term nitroglycerin treatment: effect on direct and endothelium-mediated large coronary artery dilation in conscious dogs.Transdermal Nitroglycerin and Nitrate ToleranceAUDREY G. KRIEGMAN, M.D.Factors Influencing Tolerance in Nitrate Therapy: A ReviewThe effectiveness of transcutaneous nitrate preparations for angina pectorisNitrates In The Treatment Of AnginaCorrection: Incorrect Reference in Editorial on Nitrate Tolerance 1 March 1986Volume 104, Issue 3Page: 424-426KeywordsAnginaDrugsHeart failureHemodynamicsLongitudinal studiesNitrates ePublished: 1 December 2008 Issue Published: 1 March 1986 PDF downloadLoading ...