Long-term efficacy of continuous and intermittent use of transdermal nitroglycerin in stable angina pectoris

Milliano, P. A. de; Koster, Rudolph W.; Bär, Frits W.; Janssen, James A.; Cock, CC De; Schelling, A.; Bos, AP

doi:10.1016/0002-9149(91)90399-6

Cited by 22 publications

(11 citation statements)

References 29 publications

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“…However, in this study the placebo group increased their "exercise duration" by 80 seconds at week 8, indicating either a training effect, a large placebo effect, or that patients were not stabilized at the time of randomization. In another recent parallel study, only minimal changes from baseline were seen in the placebo group [24].…”

Section: Observations In Other Studiesmentioning

confidence: 90%

“…Luke [22] 11/11 (1) 10.0 Greco [23] 26/26 (4) 10.0 Milliano [24] 38/38 (11) 10.0 Coop. [25] 338/117 (107) Plac.…”

Section: B Studies Permitting Concomitant Therapymentioning

confidence: 99%

“…Among the largest studies reporting on "exercise duration," four studies with a total number of 156 patients using 10 mg/24 hr or less reported a marked and significant improvement varying from 40 to 109 seconds [17,18,23,24]. A large crossover study with 81 patients using 20 mg/24 hr observed a 33-second improvement [20], while no significant improvement compared to placebo (only 10 seconds) was reported in the large cooperative study with 108 patients in the "low dose" group (15 and 30 mg/24 hr).…”

Section: Optimal Dosingmentioning

confidence: 99%

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The effect of transdermal nitroglycerin on exercise tolerance in relation to patch application time?a meta-analysis

Klemsdal

Gjesdal

1992

Cardiovasc Drug Ther

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Disagreeing results have been reported in the many studies on continuous treatment with nitroglycerin patches. The effects on exercise tolerance are partly studied at the end of a 24-hour application period, and partly examined only a few hours after patch renewal. The present meta-analysis estimates the overall efficacy of nitroglycerin patches in trials with and without concomitant antianginal therapy, and investigates if the treatment effect depends on the patch application time. A computed search (MEDLINE) identified 110 publications, of which 17 trials on nitrate patch monotherapy and six trials on combined therapy satisfied the inclusion criteria. Data on "exercise duration" and "ST-segment depression" were converted to a standardized treatment effect size d, and pooled to an overall treatment effect size d+. In tests 2-5 hours after patch renewal, moderate but significant effects of nitrate monotherapy were observed; d+ was 1.20 with regard to "ST-segment depression" and 0.39 with regard to "exercise duration" (both p < 0.0001). In contrast, 24 hours after patch application, the values for d+ were 0.09 (not significant) and 0.36 (p < 0.01), respectively. When adding the results from the six trials on combined therapy, d+ with regard to "exercise duration" was reduced to 0.28 (p < 0.0001) 2-5 hours after renewal and to 0.17 (p = 0.04) after 24 hours. Thus, the efficacy of continuous nitroglycerin patch treatment is moderate but evident during exercise tests 2-5 hours after patch renewal; however, it is reduced after 24 hours of patch application.

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Section: Observations In Other Studiesmentioning

confidence: 90%

“…Luke [22] 11/11 (1) 10.0 Greco [23] 26/26 (4) 10.0 Milliano [24] 38/38 (11) 10.0 Coop. [25] 338/117 (107) Plac.…”

Section: B Studies Permitting Concomitant Therapymentioning

confidence: 99%

Section: Optimal Dosingmentioning

confidence: 99%

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The effect of transdermal nitroglycerin on exercise tolerance in relation to patch application time?a meta-analysis

Klemsdal

Gjesdal

1992

Cardiovasc Drug Ther

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“…Although continuous therapy may be of some value, benefits are substantially less than during intermittent therapy. Numerous studies, totalling over 500 randomised patients, have demonstrated the benefits of intermittent patch therapy over continuous (Cowan et al, 1987;De Milliano et al, 1989;DeMots & Glasser, 1989;Fox et al, 1991;Luke et al, 1987;Scardi et al, 1991;Schaer et al, 1988). For this reason, where possible, intermittent therapy is preferable to continuous.…”

Section: The Role Of Intermittent Therapymentioning

confidence: 99%

Avoiding nitrate tolerance.

Cowan

1992

Brit J Clinical Pharma

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“…Eccentric dosing of nitrates with a daily nitrate-free period has been considered to produce encouraging results. De Milliano et al (7) showed that a nitrate-free interval of 10 h prevents nitrate tolerance. Waters et al (8) observed that the time-to-angina during exercise did not differ among a group given continuous nitroglycerin, a group given nitroglycerin with a "6 h-off" regimen, and a group given placebo, but was significantly longer in a group given nitroglycerin with a 10 h-off regimen.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of Nitrate Tolerance without Reducing Vascular Response during Eccentric Dosing of Nitrates

et al. 2006

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It has been reported that the nitrate tolerance related to continuous dosing of nitrates reduces drug efficacy, and therefore eccentric dosing of nitrates is recommended. In this study, we investigated the appearance of nitrate tolerance related to continuous dosing of nitrates and prevention of nitrate tolerance during eccentric dosing by comparing the grade of coronary dilatation after sublingual nitroglycerin. Of 26 patients with ischemic heart disease who underwent elective cardiac catheterization, 8 patients were continuously administered nitrates, 8 patients were eccentrically administered nitrates, and 10 patients were not treated. We compared the coronary response to sublingual nitroglycerin among the 3 groups. In a coronary vessel without significant stenosis, the coronary vessel area, coronary lumen area, and mean coronary blood flow velocity after sublingual nitroglycerin were measured using intravascular ultrasound (IVUS). In the continuous dosing group, the maximal rate of change in the vessel area after sublingual nitroglycerin was 105 ± 1

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Long-term efficacy of continuous and intermittent use of transdermal nitroglycerin in stable angina pectoris

Cited by 22 publications

References 29 publications

The effect of transdermal nitroglycerin on exercise tolerance in relation to patch application time?a meta-analysis

The effect of transdermal nitroglycerin on exercise tolerance in relation to patch application time?a meta-analysis

Avoiding nitrate tolerance.

Inhibition of Nitrate Tolerance without Reducing Vascular Response during Eccentric Dosing of Nitrates

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