The therapeutic role of isosorbide-5-mononitrate+ in stable and unstable angina pectoris.

Various studies on the pharmacodynamic and clinical properties of isosorbide-5-mononitrate (IS-5-MN) indicate that this drug is effective in the treatment of stable angina pectoris. Acute and chronic studies, in fact, show an improved performance and an amelioration of the clinical status in patients under treatment. On the other hand, acute studies on vasospastic and mixed angina, two common clinical manifestations of coronary artery disease, have demonstrated the capability of IS-5-MN in preventing episodes of transient myocardial ischemia. In analogy with other forms of nitrates, it is clear that IS-5-MN has a positive effect both on the coronary tree (preventing vasoconstriction) and on those hemodynamic parameters which influence the myocardial oxygen demand (reducing myocardial oxygen consumption). Further information is needed, however, to clarify the issue of tolerance development after chronic administration; so far it appears that tolerance may develop when patients are treated with doses of IS-5-MN greater than 20 mg t.i.d.. On the basis of the clinical studies carried out with IS-5-MN, and its favourable pharmacological profile, it is foreseeable that this drug will have an increasing role in the treatment of angina pectoris.