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Previous Volume 338:520-531 February 19, 1998 Number 8 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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The organic nitrates are widely used in the management of coronary artery disease. They are given not only to patients with stable angina pectoris, but also to those with unstable angina, acute myocardial infarction, and heart failure. Although they are effective for the treatment of these disorders, their therapeutic value is compromised by the rapid development of tolerance during sustained therapy. This review will be limited to the use of organic nitrates in patients with chronic stable angina pectoris, but many of the principles enunciated are relevant to other clinical situations.

In 1879 Murrell reported that a 1 percent solution . . . [Full Text of this Article]

Pharmacology of Organic Nitrates

Mechanisms of Action of the Organic Nitrates

Organic Nitrates in the Treatment of Angina

Treatment of Episodes of Angina

Prevention of Angina with Nitroglycerin

            Sublingual Nitroglycerin

            Oral Nitroglycerin

            Nitroglycerin Ointment

            Nitroglycerin Transdermal Patches

Prevention of Angina with Isosorbide Dinitrate

            Sublingual Isosorbide Dinitrate

            Standard-Formulation Isosorbide Dinitrate

            Sustained-Release Isosorbide Dinitrate

Prevention of Angina with Isosorbide Mononitrate

            Standard-Formulation Isosorbide Mononitrate

            Sustained-Release Isosorbide Mononitrate

Nitrates as Initial Preventive Therapy

Combination Therapy

Nitrate Tolerance

Sulfhydryl-Depletion Hypothesis

Neurohormonal Hypothesis

Plasma-Volume-Expansion Hypothesis

Free-Radical Hypothesis

Prevention of Nitrate Tolerance

Problems with Intermittent Nitrate Therapy

Conclusions

Source Information

From the Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto (J.D.P.), and the Department of Medicine, Queen's University, Kingston General Hospital, Kingston, Ont. (J.O.P.) — all in Canada.

Address reprint requests to Dr. John D. Parker at Mount Sinai Hospital, Suite 1609, 600 University Ave., Toronto, ON M5G 1X5, Canada.

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