Nitrates are vasodilators of venous and arterial smooth muscle commonly prescribed both for angina and congestive heart failure. Primarily venodilators, nitrates also affect the systemic circulation if administered in sufficient dosage. In the coronary circulation, the principal effect is on the large epicardial and collateral vessels. Blood is shunted toward the ischemic subendocardium. In the majority of patients with angina, relief of symptoms by nitrates is primarily due to hemodynamic effects on preload and afterload, unless the patient has coronary spasm. In patients with congestive heart failure, nitrates decrease the resistance to the emptying of blood from the left ventricle as well as the filling pressure. Nitrates are relatively well tolerated, except for an initial throbbing headache which rapidly resolves as tolerance develops. Nitrates are available in a multitude of forms including sublingual, oral, topical, transmucosal, intravenous, and spray preparations. Oral preparations undergo a first-pass effect in the liver, requiring larger doses. Other forms avoid this problem by direct trans-dermal absorption or the intravenous route. The latter has the advantage of rapid administration and ease of titration. The choice of nitrate depends upon the clinical situation.

Keywords:
Nitrates, Nitroglycerin, Angina, Congestive heart failure
This content is only available via PDF.
© 1985 S. Karger AG, Basel
1985
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.