title: Increased exercise tolerance and reduced duration of ischemia after isosorbide dinitrate oral spray in angina pectoris.
abstract: The prophylactic and therapeutic anti-ischemic efficacy of isosorbide dinitrate (ISDN) oral spray was assessed in 10 patients with coronary artery disease and stable angina pectoris. The patients entered a randomized crossover study of ISDN spray and placebo, involving bicycle exercise testing. Each patient underwent 2 exercise tests at least 4 hours apart. Immediately before initiation of exercise they received either ISDN spray or placebo and crossed over during the other test. ISDN spray delayed the onset of anginal pain by about 40%, from a mean of 5.1 +/- 1.4 minutes with placebo to 7.2 +/- 1.3 minutes with the active drug (p less than 0.001). Time of onset of ST-segment depression was also significantly prolonged, from 7.1 +/- 1.5 minutes with placebo to 10.2 +/- 1.2 minutes with ISDN (p less than 0.001). The patients achieved a higher double product at onset of pain with ISDN than with placebo. The drug also reduced the time of disappearance of pain after discontinuation of exercise from 3.2 +/- 0.7 to 2.1 +/- 0.8 minutes (p less than 0.001), and the time of disappearance of electrocardiographic changes from 4.2 +/- 0.6 to 2.5 +/- 0.8 minutes (p less than 0.005). These findings indicate that oral ISDN spray is an effective prophylactic for exercise-induced angina. Its rapid onset of action makes it especially suitable for usage immediately before exercise.
authors.affiliation: Department of Cardiology, Rebeca Ziev Medical Center, Safad, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Marmor
authors.forename: M
authors.initials: M
authors.lastname: Plich
authors.forename: D
authors.initials: D
authors.lastname: Blondheim
authors.forename: T
authors.initials: T
authors.lastname: Sharir
authors.forename: J S
authors.initials: JS
authors.lastname: Alpert
mesh_terms: D000284:Administration, Oral; D000336:Aerosols; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000150:complications; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D013997:Time Factors
chemical_list: D000336:Aerosols; D007548:Isosorbide Dinitrate