Copyright © 1989 by the European Society of Cardiology.
© 1989 The European Society of Cardiology
Intermittent transdermal nitroglycerin monotherapy in stable exercise-induced angina: A comparison with a continuous schedule
Department of Cardiology, De Gasperis Centre, Niguarda Hospital Milan, Italy
Received 14 November 1988; revised 17 April 1989; .
Address for correspondence: Dr Maurizio Ferratini, Via Rosellini 26, 20144 Milan, Italy
Abstract
The aim of this study was to investigate nitrate tolerance during continuous treatment with nitroglycerin patches (NTG) as monotherapy, and to assess whether tolerance might be prevented by an overnight nitrate-free interval. Ten male patients, of mean age 53.2 years (range 41–62 years), with pathological coronary angiography and stable exercise-induced angina pectoris took part in a double-blind crossover study (two 15-day periods), during which the continuous and intermittent (12-h nitrate-free interval) application of NTG 20 mg (24 h)–1 patches were compared. Single-blind placebo was given acutely before and at the end of the crossover. Exercise testing was performed on a treadmill according to the Bruce protocol 4 and 12 h after dosing, both during placebo and at the end of the two active treatment periods.
In comparison with continuous treatment, the intermittent administration of 20 mg (24 h)–1 NTG patches significantly increased ischaemic threshold and total work time at the 4th and the 12th hour. Night-time withdrawal of NTG transdermal delivery systems determined during the 15-day period a total of 11 night anginal attacks in six out of 10 patients (0.07 attacks per patient per nitrate-free interval).
Key Words: Nitroglycerin tolerance • effort angina
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