Avoiding nitrate tolerance.

Cowan, J. C.

doi:10.1111/j.1365-2125.1992.tb04116.x

Cited by 13 publications

(8 citation statements)

References 42 publications

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“…However, this strategy has been viewed with caution because of the potential rebound risk and consequent outcomes (e.g., myocardial infraction and death). 61 , 62 The use of sulfhydryl donor therapy (e.g., acetylcholine, methionine, and captopril) has similarly been associated with undesirable adverse events.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

et al. 2018

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BackgroundPostoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass graft (CABG) surgery. This arrhythmia occurs more frequently among patients who receive perioperative inotropic therapy (PINOT). Administration of nitrates with antiplatelet agents reduces the conversion rate of cyclic guanosine monophosphate to guanosine monophosphate. This process is associated with increased concentrations of free radicals, catecholamines, and blood plasma volume. We hypothesized that patients undergoing CABG surgery who receive PINOT may be more susceptible to POAF when nitrates are administered with antiplatelet agents.MethodsClinical records were examined from a prospectively maintained cohort of 4,124 patients undergoing primary isolated CABG surgery to identify POAF-associated factors.ResultsPOAF risk was increased among patients receiving PINOT, and the greatest effect was observed when nitrates were administered with antiplatelet therapy. Adjustment for comorbidities did not substantively change the study results.ConclusionsAdministration of nitrates with certain antiplatelet agents was associated with an increased POAF risk among patients undergoing CABG surgery. Additional studies are needed to determine whether preventive strategies such as administration of antioxidants will reduce this risk.

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Section: Discussionmentioning

confidence: 99%

Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

et al. 2018

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“…Some reports have indicated that intermittent nitrate administration causes rebound angina during the nitrate-free intervals (3)(4)(5)(6), whereas others reports describe rebound angina as negligible and intermittent administration as safe (7)(8)(9)(10)(11)(12)(13). One of the characteristics of rebound angina is hypersensitivity to vasoconstrictive substances (7,9,(14)(15)(16). This means that rebound angina may be especially problematic in patients with variant angina, as is commonin Japan.…”

Section: Introductionmentioning

confidence: 91%

“…In his review of nitrate use, Cowanendorsed combining them with P-blockers to prevent rebound angina which occurred in 2 to 4%of the 500 cases he evaluated (16). However, in the Japanese, coronary vasospasm is frequently seen, and some have suggested that (3-blockers may aggravate that condition.…”

Section: Effect Of Combining Medicationsmentioning

confidence: 99%

Intermittent Nitrate Therapy for Prior Myocardial Infarction Does Not Induce Rebound Angina nor Reduce Cardiac Events.

et al. 2000

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Objective Long-term nitrate therapy for ischemic heart disease may cause drug tolerance which diminishes its beneficial effects ; consequently, intermittent administration of nitrates is recommended. With this regimen, however, the potential occurrence of rebound angina during the nitratefree intervals is a source of concern. Subjects and MethodsWecarried out a retrospective study of 606 patients to determine whether rebound angina occurred whenconventional continuousnitrate administration was replaced by intermittent administration as part of a long-term therapy protocol for prior myocardial infarction. Thesubjects were receiving treatment for myocardial infarction and included 293 patients treated with nitrates (Nitrate group) and 313 patients who were not (Nonitrate group). The former included 186 patients who received intermittent nitrate administration (Intermittent group) and 107 patients who received continuous administration (Continuous group). The mean period of observation was 4.3+1.6 months.

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“…Despite the organic nitrates being in medical use for over a century, they remain commonly used in the prophylaxis and treatment of angina pectoris and cardiac failure ( 1). A major drawback to continuous nitrate therapy is the rapid manifestation of ‘nitrate tolerance’ ( 2), a loss of both haemodynamic and anti‐anginal properties associated with sustained nitrate use. This effect is seen particularly with the application of transdermal formulations where 24 h nitrate administration can be achieved ( 3).…”

Section: Introductionmentioning

confidence: 99%

Managed substitution of modified release nitrates with an asymmetric dosing regimen

Holmes

Holden

2000

J Clin Pharm Ther

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Avoiding nitrate tolerance.

Cited by 13 publications

References 42 publications

Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

Intermittent Nitrate Therapy for Prior Myocardial Infarction Does Not Induce Rebound Angina nor Reduce Cardiac Events.

Managed substitution of modified release nitrates with an asymmetric dosing regimen

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