Requiem

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Have you guys in hospital seen this? What do you think of it?

I've gone through pubmed, uptodate, e-therapeutics, lexi, product monograph -> found absolutely no evidence to support use greater than 24 hrs continuously.

Tolerance is demonstrated to develop through 3 mechanisms, the first cases interestingly being demonstrated through bomb makers who used to work on nitroglycerin found they'd get headaches and feel lightheaded after working with it - but after a couple of days they'd feel fine.
 

PharmDstudent

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Why are they using it like that? What are their intentions? *cough* *cough* Where the heck are you coming from? *cough* *cough*
 

Old Timer

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There is no clinical evidence that I am aware of that shows long acting nitrates should be given without a drug free interval.....
 

Pharmavixen

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A couple of years ago, we had an inmate who insisted his nitro patches stay on 24/7. We didn't let him do that, of course, so through his lawyer he went to the media saying that he had a very serious heart condition, and we were giving him his heart medications wrong. So the bosses dragged me into it, and I had to write a report saying that we were giving the medications properly, taking directions from the inmate's cardiologist.

Of course the paper printed an article saying how the nasty ol' jail was failing to provide proper medical care to this poor, poor heart attack survivor (a nasty piece of work who had killed a homeless man in a fit of rage, btw), but no retraction was ever printed.

[/rant]

We shipped this guy to the penitentiary, where within a year, he died. Maybe they let him wear his nitro patches all the time.
 

npage148

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There is no evidence for this. At best, it's ineffective and tolerance develops and at worse it propensate epithelial dysfunction and increases the overall level of oxidative stress in the vasculature.

Tolerance develops via thiol oxidation of various enzymes and receptors integral to organic nitrate bioactivation and nitric oxide synthesis, and vascular tone