Posted: 11 Apr 08
Edited: 8 Aug 18
Audits Cardiovascular
Oral nitrates are effective as long-term symptomatic therapy when used once daily as a sustained release preparation, or as an asymmetric twice-daily preparation (e.g. 8a.m. and 2 p.m.). Both isosorbide dinitrate and isosorbide mononitrate have been shown in controlled trials to be superior to placebo in controlling symptomatic angina(1). Standard tablets of isosorbide mononitrate (ISMN) have been shown to reduce tolerance when given twice daily using an asymmetric dosing interval. This allows a nitrate-free period of 6 to 8 hours. (2). SIGN 5I recommended that oral nitrates can be used as a satisfactory monotherapy in the treatment of long-term angina symptoms (1) provided it is used in a way which avoids nitrate tolerance (e.g. in an asymmetric dose schedule).