Mononitrates pp 147-153 | Cite as

A Double-Blind Cross-Over Study on the Effectiveness and Possible Development of Tolerance during Long-Term Therapy with Isosorbide-5-Mononitrate or Isosorbide Dinitrate Slow-Release in Coronary Artery Disease

  • U. Rennhak
  • T. Riebesel
  • G. Biamino
Part of the International Boehringer Mannheim Symposia book series (BOEHRINGER)

Abstract

It is well known that all types of nitrates are effective in angina pectoris syndrome. However, nearly 100-year old reports indicate that chronic treatment with high dosages of nitroglycerin may induce a tolerance with regard to its effect on reducing blood pressure [11, 12]. With the introduction of long-acting orally applicable nitrates the discussion has reopened with regard to whether long-term administration of multiple daily dosages of these drugs reduces the efficacy in angina pectoris syndrome. Although this hypothesis is supported by several studies [1, 5, 7, 10, 13, 14], the results are not generally accepted [2, 6, 8].

Keywords

Angina Pectoris High Serum Concentration Isosorbide Dinitrate Anginal Attack Ergometric Exercise 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Blasini R, Brügmann U, Mannes A, Froer K-L, Rudolph W (1980) Wirksamkeit von Isosorbid-dinitrat in retardierter Form bei Langzeitbehandlung. Herz 5: 298–305PubMedGoogle Scholar
  2. 2.
    Danahy DT, Aronow WS (1977) Hemodynamics and antianginal effects of high dose oral iso-sorbide dinitrate after chronic use. Circulation 56: 205PubMedGoogle Scholar
  3. 3.
    Fung H-L, Parker JO (1983) Prolonged plasma half-life time after oral isosorbide dinitrate in patients with angina pectoris. Br J Clin Pharm 15: 746–748Google Scholar
  4. 4.
    Fung H-L (1983) Pharmacokinetics of isosorbide dinitrate during tolerance development; In Kaltenbach M, Kober G (eds) Nitrates and nitrate tolerance in angina pectoris. Steinkopff, Darmstadt, S 25–26Google Scholar
  5. 5.
    Jansen W, Osterspey A, Fuchs M, Tauchert M, Schell U, Weste S, Hombach V (1982) Hämodynamische Wirkung von 20 mg und 50 mg 5-Isosorbidmononitrat unter akuter und chronischer Therapie. Med Welt 33/48: 1756–62PubMedGoogle Scholar
  6. 6.
    Lee G, Mason DT, De Maria AN (1978) Effects of long-term administration of isosorbide dinitrate on the antianginal vesponse to nitroglycerin. Absence of nitrate cross-tolerance and self-tolerance shown by exercise testing. Am J Card 41: 82–87PubMedCrossRefGoogle Scholar
  7. 7.
    Needleman P, Johnson EM (1973) Mechanism of tolerance development to organic nitrates. J Pharm Exp Ther 184: 709Google Scholar
  8. 8.
    Niederer W, Bethge HD, Bachmann K (1982) Nitrattoleranz, hämodynamische und ventrikeldynamische Untersuchungen. Z Kardiol 71/3: 166Google Scholar
  9. 9.
    Reifart N, Reifart F, Kaltenbach M, Bussmann W-D (1981) Vergleich der antianginösen Wirksamkeit und Wirkdauer von Isosorbiddinitrat,Isosorbid-2-Mononitrat und Isosorbid-5-Mononitrat. Med Welt Bd 32/14aGoogle Scholar
  10. 10.
    Schwarzer C, Mlczoch J (1982) Zur Frage der Toleranzentwicklung von Isosorbidmononitrat. Z Kardiol 71/167Google Scholar
  11. 11.
    Steward DD (1905) Tolerance to nitroglycerin. JAMA 44: 1678Google Scholar
  12. 12.
    Steward DD (1888) Remarkeble tolerance to nitroglycerin. Philadelphia Policlinic, p 172Google Scholar
  13. 13.
    Thadani U, Fung H-L, Darke AC, Parker JO (1982) Oral isosorbide dinitrate in angina pectoris: Comparison of duration of action and dose-response relation during acute and sustained therapy. Am J Card 49: 411–19PubMedCrossRefGoogle Scholar
  14. 14.
    Thadani U, Manyari D, Parker JO, Fung H-L (1980) Tolerance to the circulatory effects of oral isosorbide dinitrate. Circulation 61: 526–36PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1985

Authors and Affiliations

  • U. Rennhak
  • T. Riebesel
  • G. Biamino

There are no affiliations available

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