The rationale for nitrates in angina pectoris.

Organic nitrates are among the oldest drugs used in the management of patients with ischemic heart disease. The most frequently used nitrates are nitroglycerin, isosorbide dinitrate and isosorbide-5-mononitrate. Their duration of action can be influenced by choice of substance, frequency of administration, formulation (eg, extended release) and route of administration. As well as providing effective treatment of acute angina, nitrates produce a long term prophylactic effect. Stable plasma nitroglycerin levels lasting longer than 10 to 12 h are not desirable due to the rapid development of tolerance. Simple, well-designed dosing schedules can avoid tolerance and rebound phenomena and can improve patient compliance.