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  • Title: Transdermal nitroglycerin in angina pectoris: efficacy of intermittent application.
    Author: Luke R, Sharpe N, Coxon R.
    Journal: J Am Coll Cardiol; 1987 Sep; 10(3):642-6. PubMed ID: 3114351.
    Abstract:
    Continuous application of transdermal nitroglycerin appears to result in tolerance to the antianginal effect. In a double-blind study the effects of continuous (24 h/day) and intermittent (16 h/day) application of transdermal nitroglycerin in a dosage of 10 mg/day were compared with the effects of placebo in 12 patients with chronic stable angina receiving treatment with beta-adrenergic blocking or calcium channel blocking agents. Exercise performance was assessed 2 to 4 hours after initial application and after 1 week of each treatment given in random order with a 3 day interval between treatments. Exercise time to onset of angina, total exercise duration and time to 1 mm ST segment depression were all significantly increased after initial application during the continuous and intermittent treatment periods. These increases were maintained after 1 week of intermittent but not continuous treatment. Thus the benefit of initial application of transdermal nitroglycerin is maintained with intermittent treatment and a daily nitrate-free interval, whereas tolerance to antianginal effect occurs with continuous treatment.
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