nitrate tolerance
Last reviewed 01/2018
- can be avoided in most patients if there is a nitrate- free interval of 10-12 hours per day.
- may be the result of depletion of intracellular suphydryl groups which prevents further nitrate metabolism and nitric oxide release.
- reversed within 18 hours of stopping nitrates.
- if tolerance is supected in the case of modified isosorbide dinitrate (and conventional preparations of isosorbide mononitrate) then the second of two daily doses can be given after about 8 hours rather than after 12 hours.
- there is no relationship to tolerance to adverse and therapeutic effects.
- toleance may develop in less than 48 hours after the initiation of treatment with nitrates.