By Dr. Adam Schneeweiss, Dr. Marija Weiss (auth.)
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Extra info for Advances in Nitrate Therapy
Beta-blockers have specific adverse effects, such as cold extremities, vivid dreams and impotence, which are almost never observed with nitrates. Verapamil causes constipation which might be intolerable, particularly in elderly patients. Nifedipine causes edema in about 20% of the patients. Headache, which often accompanies the initiation of nitrate therapy might be intolerable in some patients. No large-scale studies have specifically compared the frequency of adverse effects of the three classes of antianginal agents.
8. Adverse Effects Hypotension is a major adverse effect of all three classes of antianginal drugs. For calcium antagonists and beta-blockers this effect is usually sustained unless the dose is reduced. For nitrates, however, the initial hypotensive effect is almost always very rapidly attenuated. Beta-blockers have specific adverse effects, such as cold extremities, vivid dreams and impotence, which are almost never observed with nitrates. Verapamil causes constipation which might be intolerable, particularly in elderly patients.
The most recent studies from this group, however, used long-acting formulations of nitrates, namely transdermal nitroglycerin disks and ISDN ointment, which might have special problems. The possibility of tolerance to transdermally administered nitrates is discussed separately in the chapter on this topic. Studies on Long-Term Use of Nitrates in Angina Pectoris 39 long-term use of new nitrate formulations will clarify this point. Some preliminary studies with IS-5-MN suggest a sustained efficacy, without tolerance, although other studies indicate that mononitrates resemble other nitrates in this respect.