Long-term responses to nifedipine in patients with coronary spasm who have an initial favorable response.
Twenty-six patients with angina and coronary spasm participated in a randomized crossover trial comparing nifedipine with isosorbide dinitrate. Eighteen patients had a short-term beneficial response to nifedipine, and 14 of these were followed up for an average period of 9.4 months. During follow-up study, nifedipine was the primary therapy in these 14 patients, but other drugs were added when clinically necessary to control angina. There was an overall 86% beneficial response rate (greater than 50% decrease in angina frequency). However, 2 patients had a large increase (greater than 10 times) and 4 patients had a slight increase (transient) in angina frequency over the long term compared with the short-term response. The other 8 patients had a similar angina frequency compared with the short-term response. Of the 12 patients with a good response (transient slight increase or no change), 8 (67%) required additional drug therapy to maintain angina control. Nifedipine was discontinued in 2, and the dose was decreased in 3 of the 14 patients because of adverse effects. Three patients had a marked increase in angina at 9, 14, and 3 months, requiring hospitalization; 1 patient had coronary bypass for symptom control. Thus, patients with coronary spasm selected because of a favorable short-term response to nifedipine were effectively treated over the long term with nifedipine; however, additional therapy was often needed to control symptoms. Adverse effects were common, but simple reduction of nifedipine dose usually diminished the unwanted effects of the drug.
D000787:Angina Pectoris / Q000188:drug therapy; D003329:Coronary Vasospasm / Q000188:drug therapy*; D004311:Double-Blind Method; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use; D008297:Male; D009543:Nifedipine / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D011897:Random Allocation; D013997:Time Factors
D011725:Pyridines; D009543:Nifedipine; D007548:Isosorbide Dinitrate