Dose-response relation of antianginal activity of isosorbide dinitrate

Eleven men with angiographic evidence of coronary heart disease and stable, exercise-induced angina pectoris were given placebo (P) or isosorbide dinitrate (ISDN) in a daily dose of 30, 120, 240 or 480 mg, in a randomized single-blind trial. The daily doses were administered 6 times a day as single oral doses of 5, 20, 40 and 80 mg. Each dose or placebo was given for 7 days. Before therapy was begun, and on the seventh day of each treatment period, an exercise ECG with standardized level and duration of exercise was recorded. Subsequently, a 4-week treatment period with 480 mg/day was carried out at the end of which another stress test was performed. The was followed by a final 2-week placebo period. The frequency of anginal attacks per week tended to decrease with increasing nitrate doses, but decreased significantly only after the highest dose (480 mg/day) compared with placebo. Continuation of therapy with 480 mg/day maintained the reduced rate of anginal attacks. The ischemic response, expressed as the sum of ST-segment depressions in the exercise ECG, revealed a dose-dependent reduction of 26% (30 mg/day), 39% (120 mg/day) (p less than 0.01), 63% (240 mg/day) (p less than 0.01) and 72% (480 mg/day) (p less than 0.01), respectively. At the end of the 4-week treatment period with 480 mg/day, antianginal efficacy was found to be moderately reduced, showing a 56% reduction of ischemic response compared to the placebo trial. The time of onset of angina during exercise testing was also delayed in relation to the dosage given.(ABSTRACT TRUNCATED AT 250 WORDS)

Differences in the production of methemoglobin during high-dose treatment with isosorbide dinitrate or isosorbide 5-mononitrate

12 patients with coronary heart disease were studied to see whether high doses of isosorbide dinitrate (ISDN, Corovliss) or isosorbide 5-mononitrate (IS-5-MN, Ismo) increase the erythrocyte methemoglobin production in an acute experiment and after 4 days of medication. The patients were divided into two groups. Group 1 (6 patients) was given a single dose of 80 mg ISDN on the morning of day 1 and Group 2 (6 patients) was given 80 mg IS-5-MN as a single oral dose. Under the influence of the IS-5-MN no change was observed from the initial methemoglobin (met-Hb) value (0.81% of the total Hb) at measurements performed 1 and 2 h after the administration of the drug. In Group 1 (ISDN) the initial met-Hb value was 0.58% of the total Hb, a slight increase to 0.70% being observed after 1 h and to 0.77% after 2 h (p less than 0.05). The patients were then treated as follows for a further 4 days: Group 1 480 mg ISDN/d, Group 2 480 mg IS-5-MN/d. On day 5 the initial met-Hb values in both groups were unchanged compared to day 1. The patients were then given first 80 mg ISDN (Group 1) or 80 mg IS-5-MN (Group 2) and 4 h later a single dose of 160 mg of the appropriate substance. In Group 2 (IS-5-MN) the met-Hb content remained unaffected. In Group 1 a slight increase of the met-Hb to 0.79% occurred 1 h after 80 mg ISDN and to 0.9% after 2 h (p less than 0.05). The dose of 160 mg ISDN gave rise to a further slight increase to 1.00% (after 1 h) and 1.13% (after 2 h) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Medico-psychological base and trend documentation in a residential facility for rehabilitation of the handicapped]

The article presents the system for medical-psychological base and trend documentation developed between 1977 and 1980 at Rotenburger Anstalten der Inneren Mission (Home Mission). A practicable system from the user angle, it is operated on a mediumsized data processing unit. Being a pure dialogue system with programme generators, it is easy to handle and flexible in its possible applications, several of which are illustrated by examples from the rehabilitative field. As the various characteristics used can easily be attributed with other contents, and as the data base can moreover be expanded, the documentation system could also be used by comparable facilities that have the necessary electronic data processing equipment at their disposal.

[Dose-effect relationship of isosorbide dinitrate in the treatment of angina pectoris (author's transl)]

Fifteen males with angiographic evidence of coronary heart disease and stable, exercise-induced angina pectoris were given placebo or isosorbide dinitrate (ISDN) in a dialy dose of 30 mg, 120 mg, 240 mg and 480 mg in a randomized single-blind trial. The daily doses were given as a single oral dose of 5 mg, 20 mg, 40 mg and 80 mg tablets. Each dose and placebo was given for seven days. On the seventh day an exercise ECG of standardized level and duration of exercise was recorded. The ischaemia response in the ECG revealed a dose-dependent reduction by 28% (5 mg ISDN), 43% (20 mg), 60% (40 mg) and 73% (80 mg). The number of anginal attacks similarly fell parallel to dose. Plasma level of ISDN and the mononitrates, measured one and four hours after drug intake, rose almost linearly in relation to dose. Oral ISDN thus has a dose-dependent effect on the frequency of angina and ischaemia parameters during ergometric exercise. The protracted anti-anginal effect of ISDN is largely due to its metabolites. At high doses there is presumably an added effect of the high blood level of the basic substance.U