Nitroglycerin stable angina

S. Savonitto, M. Motolese, and E. Agabiti-Rosei. Antianginal effect of transdermal nitroglycerin and oral nitrates given for 24 hours a day in 2456 patients with stable angina pectoris. Int. J. Clin. Pharmacol. Ther. 33 194—203, 1995. 

Nitrate therapy should be the first step in managing acute attacks of chronic stable angina if the episodes are infrequent (e.g., a few times per month). If angina occurs no more often than once every few days, then sublingual nitroglycerin tablets or spray or buccal products may be sufficient. 

Parker JO, Vankoughnett KA, Farrell B. Comparison of buccal nitroglycerin and oral isosorbide dinitrate for nitrate tolerance in stable angina pectoris. Am J Cardiol 1985 56(12) 724-8. 

Muiesan ML, Boni E, Castellano M, Beschi M, Cefis G, Cerri B, Verdecchia P, Porcellati C, Pollavini G, Agabiti-Rosei E. Effects of transdermal nitroglycerin in combination with an ACE inhibitor in patients with chronic stable angina pectoris. Eur Heart J 1993 14(12) 1701-8. 

Verapamil increases exercise tolerance in patients with stable angina and reduces the frequency of anginal attacks, particularly when used in combination with nitroglycerine. 

DeMots, H., and Glasser, S. P. (1989). Intermittent transdermal nitroglycerin therapy in the treatment of chonic stable angina. /. Am. Coll. Cardiol. 13, 786-793. 

Boje KM, Fung H-L, Yoshitomi K, Parker JO. Haemodynamic effects of combined oral nifedipine and sublingual nitroglycerin in patients with chronic stable angina. EurJ Clin Pharmacol (1987)33, 349-54. 

Nitroglycerin has long been used for the treatment of acute attack of angina pectoris, and its stable analogs are available to prevent the anginal attack. Nitrovaso-dilators such as sodium nitropmsside liberate NO from their molecules in the tissue (thus, called NO donors) and elicit actions via cyclic GMP like those seen with endogenously synthesized NO. 

Organic nitrates (and nitrites) are simple nitric and nitrous acid esters of alcohols. They differ in their volatility for example, isosorbide dinitrate is solid at room temperature, nitroglycerin is only moderately volatile, whereas amyl nitrate is extremely volatile. These compounds cause a rapid reduction in myocardial oxygen demand followed by rapid relief of symptoms. They are effective in stable and unstable angina, as well as Prinzmetal s or variant angina pectoris. 

---