Comparative evaluation of sublingual long-acting nitrates

Ten hospitalized patients performed two exercise tests per day on five consecutive days to determine the efficacy and duration of action of three sublingual long-acting nitrate preparations: isosorbide dinitrate, pentaerythritol trinitrate, and erythrityl tetranitrate. The duration of exercise to the point of ischemia, manifest as typical anginal pain and/or 1.0 mm ST-segment depression, was determined 45 min and 100 min after each long-acting nitrate was administered.

These results were compared with the duration of exercise after placebo and two minutes after nitroglycerin administration. The mean durations of exercise in two tests after placebo were 62.5 sec and 58.4 sec (not significant) and the mean durations of exercise after nitroglycerin administration were 90.5 sec and 88.4 sec, both different from placebo ( P < .001). There was no difference from placebo found 55 min after taking nitroglycerin. The mean durations of exercise 45 min after erythrityl tetranitrate, isosorbide dinitrate and pentaerythritol trinitrate were 89.1, 87.5, and 87.5 sec respectively and all were different from placebo ( P < .01). Mean durations of exercise 100 min after erythrityl tetranitrate, isosorbide dinitrate, and pentaerythritol trinitrate were 76.4, 75.5, and 69.7 sec and none were significantly different from placebo.

This study indicates that each long-acting nitrate is effective for at least 45 min and suggests that they should not be given on a fixed dosage schedule but rather should be taken prophylactically whenever an angina-provoking situation is anticipated.

Treadmill exercise protocols to demonstrate effectiveness of nitrate drugs in relief of angina pectoris; duration of action and degree of functional enhancement

During constant uninterrupted exercise with mild angina present, either placebo, nitroglycerin, isosorbide dinitrate or erythrityl trinitrate was given by buccal membrane absorption. Placebo produced no relief and exercise had to be stopped. Nitroglycerin produced rapid complete relief and the long-acting drugs effected relief more slowly but of long duration as shown on repetitive walks as long as 3 h after drug administration.

[Clinical and statistical study of 121 cases of acute myocardial infarct from 1976 to 1981 (month of April). Critical review]

The authors realized a retrospective clinical-statistical study about 121 cases of acute myocardial infarction (AMI), treated in the Department of general medicine with a pharmacological association of Lysine acetylsalicylate--Erythrityl tetranitrate--Papaverine hydrochloride, with the purpose of obtaining a vasodilatation on coronary arteries and a platelet antiaggregation, in the light of the new etiopathogenetic views about the prolonged coronary spasm and the platelet aggregation, in some cases of myocardial infarction with or without thrombosis. Obtained data are very optimistic about incidence of left ventricular insufficiency and (of) thromboembolisms, to they augur the sistematic adoption of this treatment of AMI, especially as to the early antiaggregation therapy.

Contact dermatitis due to nitroglycerin ointment

Topical nitroglycerin ointment is among the most effective long-acting vasodilators currently available. We report two cases of contact dermatitis in which patch testing showed allergy to nitroglycerin-containing compounds. The severity of this dermatitis necessitated the discontinuation of topical nitroglycerin therapy in both patients. A potent corticosteroid cream applied once to previous nitroglycerin application sites prevented or minimized this dermatitis and enabled continuation of topical nitroglycerin therapy. Contact dermatitis due to topical nitroglycerin preparations may be more common than is presently realized.

Erythrityl tetranitrate; drug efficacy study implementation; revocation of exemption; opportunity for a hearing--FDA. Notice

The Food and Drug Administration (FDA) is revoking the temporary exemption that has allowed single-entity coronary vasodilator drug products containing erythrityl tetranitrate to remain on the market beyond the time limits scheduled for implementation of the Drug Efficacy Study. FDA is announcing that the products lack substantial evidence of effectiveness and is offering an opportunity for a hearing on a proposal to withdraw approval of any applicable new drug applications (NDA's) or abbreviated new drug applications (ANDA's).