Nitrate Therapy in Heart Failure

Abstract

Nitrates are drugs of first choice in patients with acute heart failure. Acute pulmonary edema can be successfully treated with single or repeated doses of sublingual nitroglycerin. In cases of prolonged acute heart failure, e.g. in the setting of acute myocardial infarction, nitroglycerin or isosorbide dinitrate can be given by the intravenous route for up to 24 h. Patients with acute myocardial infarction usually benefit from nitrate therapy if filling pressures are high and/or left ventricular function is compromised. Nitrate therapy can be considered safe if arterial blood pressure is maintained above 95 mm Hg. With these precautions nitrates can reduce infarct size and the incidence of complications as well as improve long-term prognosis. In the chronic treatment concern has risen with regard to possible nitrate tolerance. Thus, therapy schedules allowing for nitrate-poor phases are generally recommended. Therapy schedules with constant-rate delivery of drugs achieved with patches or intravenous administration of nitrates should be used with caution.

Acute hypertensive pulmonary edema: a new paradigm

“…Nitroglycerin is venoselective, and recent studies documenting its benefit in acute pulmonary edema (Bertini et al 1997;Schneider et al 1991) support the hypothesis that the syndrome is sustained by excess peripheral venous pressure. But its efficacy was questioned (Lewis 1933) until an intra- Fig.…”

Estimation of Drug–Polymer Miscibility and Solubility in Amorphous Solid Dispersions Using Experimentally Determined Interaction Parameters

“…Examples include medicated contact lenses (1-7), drug eluting stents (8)(9)(10), biodegradable implants (11)(12)(13)(14)(15)(16)(17)(18), transdermal patches (19,20), and oral formulations (21)(22)(23). Intimately blended dispersions require miscibility between the drug and polymer and lead to an amorphous system where the apparent solubility and bioavailability of poorly water soluble drugs can be enhanced (22)(23)(24)(25)(26).…”