Pentaerythritol Jetranitrate in the Jreatment of Angina Pectoris

Nitroglycerin and nitrate esters

The expanding applications of nitroglycerin and nitrate esters--in congestive heart failure, in the reduction of infarct size in myocardial infarction and in the long-term prophylaxis of angina--have enhanced the clinical importance of these drugs. This article reviews some of the significant recent investigations of the nitrates and makes specific recommendations regarding clinical use.

Nitroglycerin and other nitrites in the treatment of angina pectoris; comparison of six preparations and four routes of administration

The close chemical relationship between glyceryl trinitrate and erythrol tetranitrate suggests that these 2 drugs, despite clinical evidence to the contrary, should be equally effective in preventing attacks of angina pectoris. This proved to be true when the drugs were administered by the same route. Thus, erythrol tetranitrate when administered sublingually (instead of being swallowed, as is the custom) behaves like nitroglycerin and is one of the most effective vasodilators available. Conversely, nitroglycerin when swallowed (instead of being taken sublingually, as is the custom) is ineffective and erratic in activity. A similar striking increase in vasodilating action on sublingual administration is seen also with mannitol hexanitrate and triethanolamine trinitrate and to a lesser extent with pentaerythritol tetranitrate but not with sodium nitrite.

The prolonged effect of erythrol tetranitrate, when administered sublingually or in the buccal pouch, makes it particularly valuable in the clinical management of patients with angina pectoris.