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LEARNING TO LIVE WITH THE EFFECTS OF A HEART ATTACK: LONG-TERM DRUG THERAPY: NITRATES
Nitroglycerin has been used successfully to treat angina pectoris for over 100 years. In the course of time, other nitrates from the same major group have also been shown to be effective in both clinical and experimental tests. Thus their range of application could be broadened. Nitrates reduce the work load of the heart by widening the blood vessels and decreasing the peripheral resistance of the musculature. For this reason, nitrates are used not only to treat symptoms of heart pain and chest tightness, but also to treat the acute stages of impending heart attack as well as many forms of congestive heart failure. The following questions about nitrates are frequently raised:
Should strong drugs such as those in the nitrate group be used sparingly?
The answer is no, because the side-effects even of long-term drug therapy are harmless. These unusually effective and safe drugs which protect the heart and contribute to its functioning should be used generously as directed.
Should nitrates be taken only in the case of an attack of angina pectoris?
The answer is no, because nitrates should be taken preventively in situations which usually cause an attack of angina pectoris. In our opinion, nitrates are not taken as frequently as they should. All medications which contain isosorbitdinitrate are effective for approximately 4 hours, and should therefore be taken four to six times a day. (Be sure to read the package inserts with your drugs.) Since nitrates improve the function of the heart, they should be taken before, rather than after the symptoms of impaired blood circulation in the heart appear.
Should nitrates be taken even if they cause headaches? The development of headaches depends on the individual's
tolerance for nitrates and also on the dosage prescribed. They will usually disappear after a certain period of time. Moreover, the headaches indicate that the nitrates are effectively widening the blood vessels of the head. The headaches may be reduced by taking the nitrates in lower doses, for example by taking half a tablet at a time.
Zs it possible to become addicted to nitrates so that they lose their effectiveness in case of an emergency?
This fear has no basis, because patients addicted to nitroglycerin can overcome this habituation by refraining from the drug for two days. If the nitro capsules lose their effectiveness, it may be because the package is old. In the event that coronary heart disease should continue to progress, a higher dosage may be required.
Whereas patients taking other drugs such as beta blockers and digitalis must adhere to a strict daily dosage, those taking nitrates are allowed greater freedom. The patient should therefore know not only what the daily dosage is, but also what the maximum dosage is for a day when the pain is particularly strong. Needless to say, the patient should always have a reserve supply of nitrates on hand.
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Cardio & Blood/Cholesterol