title: Possible mechanisms of nitrate tolerance.
abstract: Prolonged exposure to organic nitrates has been shown to lead to the rapid development of tolerance to the peripheral and coronary vasodilatory effects of these drugs. As a result of this phenomenon, the hemodynamic and anti-ischemic effects of nitrates may be rapidly attenuated in patients with ischemic heart disease, congestive heart failure, or both. This nitrate tolerance appears to be both dose- and time-dependent. Likely mechanisms proposed for its development are multifactorial and include depletion of sulfhydryl groups, a nitrate-mediated increase in blood volume, and neurohormonal stimulation with activation of vasoconstrictive mechanisms.
authors.affiliation: Department of Medicine, University of Southern California (USC) Los Angeles 90033.
authors.forename: U
authors.initials: U
authors.lastname: Elkayam
authors.forename: A
authors.initials: A
authors.lastname: Mehra
authors.forename: A
authors.initials: A
authors.lastname: Shotan
authors.forename: E
authors.initials: E
authors.lastname: Osprzega
mesh_terms: D003326:Coronary Circulation / Q000187:drug effects; D004361:Drug Tolerance; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009566:Nitrates / Q000494:pharmacology*; D014661:Vasoconstriction / Q000187:drug effects
chemical_list: D009566:Nitrates