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: Erwina Rusmawati : Cardiology

LONG ACTING NITRATE Nitrate or nitroglycerin is one of the oldest medications available for the treatment of angina and heart disease. Nitrates are given to those patients who have angina due to narrowed blood vessels most often caused by a build up of fatty plaques known as atheromas, and work by helping the blood vessels in the body relax, allowing for blood, oxygen and nutrients to flow more smoothly and reach their target areas.1 Nitroglycerin dilates blood vessels reducing the workload of the heart and improves blood flow to the heart. Nitroglycerin is used under the tongue to treat attacks of angina. Long acting nitrates are given to those as a preventative measure and aim to inhibit pain from occuring.2 All of the nitrates (GTN, isosorbide dinitrate, and isosorbide mononitrate) come in long-acting preparations. A long-acting preparation takes longer to start working, so is not much use for immediate pain relief. But, it works for much longer after each dose than a short-acting preparation (which loses its effect after 20 minutes or so). Some preparations are slow-release or modified-release tablets. When you swallow these they gradually release a steady amount of nitrate which is absorbed into the body. Some preparations come as skin patches or ointments which release a steady amount of nitrate into the bloodstream through the skin. 3 These drugs are not useful for immediate pain relief as they take longer to work but, as they slowly release a constant amount of the drug into the body, they are better at preventing angina attacks from occuring.If a long acting nitrate is prescribed, there is a chance that you may become tolerant to it and it will stop being as effective. Due to this, the preparations and pattern of dosage are designed to allow absorption to take a place over less than 24 hours leaving the body a few hours its effects allowing the tolerance level to drop.2 As the mechanism of this groups of drugs causes the blood vessels to dilate, the patient may experience a temporary flushing of the skin as the blood is permitted through the vessels. This is more common in those taking long acting nitrates. Along with this flushing, a headache can develop along with dizziness, again these are not serious and will subside.4 If nitrate stays in your bloodstream all the time, your body becomes used to it and the nitrate then has much less of an effect. To overcome this tolerance the dose schedule aims to leave your blood free of nitrate, or with very low levels, for a few hours each day. This is why the slow-release tablets may not be prescribed at equal intervals throughout the day. This can result in your body being free of nitrate in the early hours when you are asleep.5 The use of nitrates is contraindicated in the presence of certain medical illness all of which should be discussed throughly with the doctor. They can also interfere with some medications and should not be taken with any Viagra

preparations or similar drugs. Overall nitrates are safe medications with no long term or potentially serious side efffect.4 References 1. MH., Mellow. 2011. Nitrates. http://www.sciencedirect.com/science/article.html. Accessed on 11th August 2011. At 20.15. 2. Johnson, J. 2010. Long Acting Nitrate-Cardiac Matters. http://www.cardiacmatters.co.uk/longactingnitrates.html. Accessed on 11 th August 2011. At 20.15. 3. Smith, William. 2009. Guide For Heart Attack, Heart Surgery and Cardiovascular Disease Patients. http://www.nhlbi.nih.gov/health/index.html. Accessed on 12 th August 2011. At 07.30. 4. JW, Kikendall. 2010. Effect of sublingual nitroglycerin and long-acting nitrate preparations on esophageal motility. http://ukpmc.ac.uk/abstract/MED.html. Accessed on 11 th August 2011. At 20.30. 5. Yannios, Thomas. 2009. What Even Your Doctor Doesnt Know About Preventing a Heart Attack. http://www.medtronic.com/cardiac.html. Accessed on 13 th August 2011. At 20.30.