[How nitrate tolerance be prevented in the treatment of ischemic heart disease?].
Organic nitrates are widely used for chronic treatment of ischaemic heart disease. However, the clinical value of long-term nitrate therapy is limited by the development of tolerance to their anti-anginal effects. This paper examines the different effects of nitrates, especially cellular effects. The theories put forward to explain nitrate tolerance are examined, including recent work on vascular superoxide and endothelin-1 regulation. Clinically, tolerance can be prevented by intermitted dosing of nitrates. This topic, and the practical results of work using other pharmacologic interventions in a clinical setting are discussed in the final section of this article.
Kliniki Choroby Wieńcowej Instytutu Kardiologii w Warszawie.
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Sadowski
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Kośmicki
D004334:Drug Administration Schedule; D004361:Drug Tolerance; D006801:Humans; D009131:Muscle, Smooth, Vascular / Q000187:drug effects; D017202:Myocardial Ischemia / Q000188:drug therapy*; D009566:Nitrates / Q000008:administration & dosage / Q000378:metabolism / Q000494:pharmacology*
D009566:Nitrates