LETTER
Isosorbide-5-Mononitrate in Angina Pectoris
Mike Poss, MD;
David Racicot, MD; and
W. R. Kiser, MD, MA
1 October 1994 | Volume 121 Issue 7 | Page 547
TO THE EDITOR:
The article by Thadani and colleagues [1] showed that tolerance to isosorbide-5-mononitrate (IS-5-MN) can apparently be avoided with their recommended dosage regimen, but it also appears that the drug is clinically ineffectual. The IS-5-MN and placebo groups did not differ in anginal attack rates or in the amount of supplemental nitroglycerin required during the observation period. The measure of effectiveness used in this study, specifically changes in exercise tolerance, would seem of interest in a research setting, but we question the clinical significance of the 90-second improvement 2 hours after the morning dose and the 30-second improvement noted at 12 hours.
Given that a 30-day supply of IS-5-MN at 20 mg orally, twice daily, costs the pharmacist almost $40 [6] and given the ineffectiveness of the regimen at the dosage studied, the author's demonstration of a lack of tolerance seems somewhat moot.
1. Thadani U, Maranda CR, Amsterdam E, Spaccavento L, Friedman RG, Chernoff R, et al. Lack of pharmacologic tolerance and rebound angina pectoris during twice-daily therapy with isosorbide-5-mononitrate. Ann Intern Med. 1994; 120:353-9.
2. Isosorbide mononitrate for angina. Med Lett Drugs Ther. 1992; 34:61.
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