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Role of short-acting nitroglycerin in the management of ischemic heart disease.

Boden WE, Padala SK, Cabral KP, Buschmann IR, Sidhu MS - Drug Des Devel Ther (2015)

Bottom Line: Nitroglycerin is the oldest and most commonly prescribed short-acting anti-anginal agent; however, despite its long history of therapeutic usage, patient and health care provider education regarding the clinical benefits of the short-acting formulations in patients with angina remains under-appreciated.The potential for the prophylactic effect of short-acting nitrates remains an under-appreciated part of optimal medical therapy to reduce angina and decrease myocardial ischemia, thereby enhancing the quality of life.The sublingual spray formulation provides several clinical advantages compared to tablet formulations, including a lower incidence of headache and superiority to the sublingual tablet in terms of therapeutic action and time to onset, while the magnitude and duration of vasodilatory action appears to be comparable.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Cardiology, Albany Medical College, Albany, NY, USA ; Department of Medicine, Division of Cardiology, Albany Stratton Veterans Affairs Medical Center, Albany, NY, USA ; Department of Medicine, Division of Cardiology, Albany Medical Center, Albany, NY, USA.

ABSTRACT
Nitroglycerin is the oldest and most commonly prescribed short-acting anti-anginal agent; however, despite its long history of therapeutic usage, patient and health care provider education regarding the clinical benefits of the short-acting formulations in patients with angina remains under-appreciated. Nitrates predominantly induce vasodilation in large capacitance blood vessels, increase epicardial coronary arterial diameter and coronary collateral blood flow, and impair platelet aggregation. The potential for the prophylactic effect of short-acting nitrates remains an under-appreciated part of optimal medical therapy to reduce angina and decrease myocardial ischemia, thereby enhancing the quality of life. Short-acting nitroglycerin, administered either as a sublingual tablet or spray, can complement anti-anginal therapy as part of optimal medical therapy in patients with refractory and recurrent angina either with or without myocardial revascularization, and is most commonly used to provide rapid therapeutic relief of acute recurrent angina attacks. When administered prophylactically, both formulations increase angina-free walking time on treadmill testing, abolish or delay ST segment depression, and increase exercise tolerance. The sublingual spray formulation provides several clinical advantages compared to tablet formulations, including a lower incidence of headache and superiority to the sublingual tablet in terms of therapeutic action and time to onset, while the magnitude and duration of vasodilatory action appears to be comparable. Furthermore, the sublingual spray formulation may be advantageous to tablet preparations in patients with dry mouth. This review discusses the efficacy and utility of short-acting nitroglycerin (sublingual spray and tablet) therapy for both preventing and aborting an acute angina attack, thereby leading to an improved quality of life.

No MeSH data available.


Related in: MedlinePlus

Effect of exogenous and endogenous sources of nitric oxide.Abbreviations: GMP, guanosine monophosphate; GTP, guanosine triphosphate; NOS, nitric oxide synthase.
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f1-dddt-9-4793: Effect of exogenous and endogenous sources of nitric oxide.Abbreviations: GMP, guanosine monophosphate; GTP, guanosine triphosphate; NOS, nitric oxide synthase.

Mentions: Endothelium is the innermost lining of the blood vessels; therefore, it is sensitive to circulatory mediators that contract and relax the blood vessels. Furthermore, a healthy endothelium is also able to produce mediators to promote endothelial function and maintain the tone of the blood vessels. Endothelial dysfunction decreases the production (or enhances inactivation) of the endothelium-derived relaxing factor (EDRF), which is identified as nitric oxide (NO). Organic nitrates such as nitroglycerin are converted to NO and have the ability to replenish deficient levels of EDRF and NO in patients with coronary artery disease (CAD).14 Improvement of endothelial function leads to CHD risk reduction,14 as NO released from endothelial cells activates soluble guanylate cyclase, thereby increasing the level of intracellular cyclic guanosine monophosphate (cGMP) and thus causing vasorelaxation, platelet disaggregation, and prevention of platelet adhesion (Figure 1). In addition, this protective pathway of NO-mediated endothelial effects reduces the effects of vasoconstrictor substances. Therefore, in patients with CAD, exogenous nitrate administration substitutes the effects of the impaired activity of the endothelial l-arginine/NO pathway.15


Role of short-acting nitroglycerin in the management of ischemic heart disease.

Boden WE, Padala SK, Cabral KP, Buschmann IR, Sidhu MS - Drug Des Devel Ther (2015)

Effect of exogenous and endogenous sources of nitric oxide.Abbreviations: GMP, guanosine monophosphate; GTP, guanosine triphosphate; NOS, nitric oxide synthase.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4548722&req=5

f1-dddt-9-4793: Effect of exogenous and endogenous sources of nitric oxide.Abbreviations: GMP, guanosine monophosphate; GTP, guanosine triphosphate; NOS, nitric oxide synthase.
Mentions: Endothelium is the innermost lining of the blood vessels; therefore, it is sensitive to circulatory mediators that contract and relax the blood vessels. Furthermore, a healthy endothelium is also able to produce mediators to promote endothelial function and maintain the tone of the blood vessels. Endothelial dysfunction decreases the production (or enhances inactivation) of the endothelium-derived relaxing factor (EDRF), which is identified as nitric oxide (NO). Organic nitrates such as nitroglycerin are converted to NO and have the ability to replenish deficient levels of EDRF and NO in patients with coronary artery disease (CAD).14 Improvement of endothelial function leads to CHD risk reduction,14 as NO released from endothelial cells activates soluble guanylate cyclase, thereby increasing the level of intracellular cyclic guanosine monophosphate (cGMP) and thus causing vasorelaxation, platelet disaggregation, and prevention of platelet adhesion (Figure 1). In addition, this protective pathway of NO-mediated endothelial effects reduces the effects of vasoconstrictor substances. Therefore, in patients with CAD, exogenous nitrate administration substitutes the effects of the impaired activity of the endothelial l-arginine/NO pathway.15

Bottom Line: Nitroglycerin is the oldest and most commonly prescribed short-acting anti-anginal agent; however, despite its long history of therapeutic usage, patient and health care provider education regarding the clinical benefits of the short-acting formulations in patients with angina remains under-appreciated.The potential for the prophylactic effect of short-acting nitrates remains an under-appreciated part of optimal medical therapy to reduce angina and decrease myocardial ischemia, thereby enhancing the quality of life.The sublingual spray formulation provides several clinical advantages compared to tablet formulations, including a lower incidence of headache and superiority to the sublingual tablet in terms of therapeutic action and time to onset, while the magnitude and duration of vasodilatory action appears to be comparable.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Cardiology, Albany Medical College, Albany, NY, USA ; Department of Medicine, Division of Cardiology, Albany Stratton Veterans Affairs Medical Center, Albany, NY, USA ; Department of Medicine, Division of Cardiology, Albany Medical Center, Albany, NY, USA.

ABSTRACT
Nitroglycerin is the oldest and most commonly prescribed short-acting anti-anginal agent; however, despite its long history of therapeutic usage, patient and health care provider education regarding the clinical benefits of the short-acting formulations in patients with angina remains under-appreciated. Nitrates predominantly induce vasodilation in large capacitance blood vessels, increase epicardial coronary arterial diameter and coronary collateral blood flow, and impair platelet aggregation. The potential for the prophylactic effect of short-acting nitrates remains an under-appreciated part of optimal medical therapy to reduce angina and decrease myocardial ischemia, thereby enhancing the quality of life. Short-acting nitroglycerin, administered either as a sublingual tablet or spray, can complement anti-anginal therapy as part of optimal medical therapy in patients with refractory and recurrent angina either with or without myocardial revascularization, and is most commonly used to provide rapid therapeutic relief of acute recurrent angina attacks. When administered prophylactically, both formulations increase angina-free walking time on treadmill testing, abolish or delay ST segment depression, and increase exercise tolerance. The sublingual spray formulation provides several clinical advantages compared to tablet formulations, including a lower incidence of headache and superiority to the sublingual tablet in terms of therapeutic action and time to onset, while the magnitude and duration of vasodilatory action appears to be comparable. Furthermore, the sublingual spray formulation may be advantageous to tablet preparations in patients with dry mouth. This review discusses the efficacy and utility of short-acting nitroglycerin (sublingual spray and tablet) therapy for both preventing and aborting an acute angina attack, thereby leading to an improved quality of life.

No MeSH data available.


Related in: MedlinePlus