Nitrates to prevent angina
A short-acting preparation of glyceryl trinitrate can be taken before an activity that is likely to provoke angina; see Treatment of episodes of angina for dosage.
A long-acting nitrate preparation (transdermal glyceryl trinitrate, modified-release isosorbide mononitrate) can be added either to a beta blocker, or to a nondihydropyridine calcium channel blocker (diltiazem, verapamil).
Tolerance to all forms of long-acting nitrate therapy develops rapidly. To avoid this complication, allow a nitrate-free period (ie modified-release isosorbide mononitrate taken once daily, glyceryl trinitrate patch worn for less than 14 hours per day). Long-acting nitrates do not improve survival in patients with coronary artery disease.
If adding a nitrate to beta-blocker, diltiazem or verapamil therapy to prevent angina, use:
1glyceryl trinitrate 5 mg transdermally, once daily, increasing if required up to 20 mg once daily. Apply for a maximum of 14 hours in a 24-hour period glyceryl trinitrate glyceryl trinitrate glyceryl trinitrate
OR
1isosorbide mononitrate modified-release 30 mg orally, daily, increasing if required up to 120 mg daily. isosorbide mononitrate isosorbide mononitrate isosorbide mononitrate