Transdermal Nitroglycerin and Nitrate Tolerance

Excerpt

Considerable recent data suggest that the use of transdermal nitroglycerin disks may be associated with the rapid development of nitrate tolerance. Studies in patients with angina pectoris (1-4) and congestive heart failure (5-8) have indicated that the use of this nitrate formulation, which releases drug continuously for at least 24 hours, is associated with loss of clinical and hemodynamic effects of nitroglycerin within 18 to 24 hours after initial (acute) dosing. Although these surprising observations have engendered controversy (9, 10), it seems clear that nitrate tolerance is the likeliest explanation for the similar findings shown in various investigations (1-8).

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