Oral Isosorbide dinitrate in angina pectoris: Comparison of duration of action and dose-response relation during acute and sustained therapy

Thadani, Udho; Fung, Ho‐Leung; Darke, Andrew C.; Parker, John O.; Cruise, Marjery J.

doi:10.1016/0002-9149(82)90518-5

Cited by 293 publications

(84 citation statements)

References 28 publications

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“…The clinical expression of the nitrate tolerance is a combination of a reduced dose-effect relationship, as well as a reduced duration of action of a given dose. This attenuation of effect is well documented in clinical studies (Thadani et al, 1982).…”

Section: Development Of Tolerancesupporting

confidence: 62%

Prophylactic nitrate therapy in angina pectoris‐is there an optimal treatment regimen?

Olsson¹,

Allgén²

1992

Brit J Clinical Pharma

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1. Nitrates have a place in the prophylactic treatment of patients with angina pectoris. Their efficacy is not in doubt. 2. However, there may be some practical problems associated with their use, such as unreliable absorption, short duration of action, treatment‐induced headache, development of nitrate tolerance and a suggested rebound phenomenon observed during intermittent dosing. Furthermore, patient convenience with treatment schedule and patient compliance have to be considered during prophylactic treatment. The present article discusses how many of these problems may be solved by selection of formulation as well as nitrate compound. 3. The development of controlled‐release formulations producing sufficiently high nitrate plasma concentration during part of the day followed by nitrate‐poor rather than nitrate‐ free interval, have the potential to prevent both nitrate tolerance and rebound phenomenon, and produce a sufficiently long duration of action with a convenient once daily regimen.

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Section: Development Of Tolerancesupporting

confidence: 62%

Prophylactic nitrate therapy in angina pectoris‐is there an optimal treatment regimen?

Olsson¹,

Allgén²

1992

Brit J Clinical Pharma

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“…В связи с тем, что динитрат должен подверг-нуться трансформации в мононитрат в печени, чтобы проявить свое антиангинальное действие (в течение 3-4 минут, что меньше, чем при приеме нитроглице-рина). После перорального приема гемодинамиче-ские и антиангинальные эффекты сохраняются на протяжении нескольких часов, что обеспечивает более длительную защиту от стенокардии, чем после приема нитроглицерина сублингвально [284].…”

Section: препаратыunclassified

“…В одном из ключевых, плацебо контролируемых исследований продолжительность нагрузки достоверно увеличилась на период 6-8 часов после разового перорального при-ема 15-120 мг изосорбида динитрата, и всего на период около 2 часов, если такие же дозы назначали повторно 4 раза в сутки, несмотря на более высокие плазменные концентрации изосорбида динитрата при продлен-ном, чем при остром назначении [284]. В крупном многоцентровом исследовании при использовании формы изосорбида динитрата с замедленным высво-бождением эксцентрический режим дозирования 2 раза в сутки по 40 мг утром и через 7 часов не был лучше плацебо [284]. Таким образом, пролонгирован-ная терапия изосорбида динитратом не является осно-ванной на доказатель ствах.…”

Section: препаратыunclassified

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

Montalescot

Sechtem²,

Achenbach³

et al. 2014

Russ J Cardiol

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“…Its development is most frequently associated with those formulations or dosage regimes which attempt to provide a constant plasma nitrate level (Thadani et al, 1982;Parker & Fung 1984;Parker et al, 1987a, b). In this respect, transdermal nitroglycerine patches, which deliver GTN across the skin at a constant rate over a 24 h period, have been particularly implicated (James et al, 1985;Jordan et al, 1985;Thadani et al, 1985).…”

Section: Introductionmentioning

confidence: 99%

N‐acetylcysteine fails to attenuate haemodynamic tolerance to glyceryl trinitrate in healthy volunteers.

Hogan

Henderson

1989

Brit J Clinical Pharma

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1 The effects of chronic dosing with N-acetylcysteine (NAC), on nitrate-induced haemodynamic changes during the acute and chronic treatment of healthy volunteers with glyceryl trinitrate (GTN) patches (Transiderm nitro) has been investigated. 2 Seven volunteers were treated in a double-blind randomised crossover manner for two periods of 4 days with 20 mg of transdermal GTN/24 h together with NAC (200 mg three times daily) or matching placebo. There was a washout period of >3 days between treatment periods.3 Haemodynamic measurements (blood pressure (BP); heart rate (HR)) at rest and following maximal treadmill exercise were performed before treatment and 4 h after starting treatment on days 1 and 4. 4 Significant haemodynamic changes as evidenced by a fall in BP and rise in HR, were seen on day 1 in both the NAC and placebo phases. By day 4 the haemodynamic changes had returned towards the pre-treatment values during both the NAC and placebo phases suggesting the development of tolerance in both treatment groups. 5 These findings suggest that concurrent administration of NAC fails to prevent the development of tolerance to GTN.

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Oral Isosorbide dinitrate in angina pectoris: Comparison of duration of action and dose-response relation during acute and sustained therapy

Cited by 293 publications

References 28 publications

Prophylactic nitrate therapy in angina pectoris‐is there an optimal treatment regimen?

Prophylactic nitrate therapy in angina pectoris‐is there an optimal treatment regimen?

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

N‐acetylcysteine fails to attenuate haemodynamic tolerance to glyceryl trinitrate in healthy volunteers.

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