Nitroglycerin and Other Nitrites in the Treatment of Angina Pectoris

Abstract

The close chemical relationship between glyceryl trinitrate and erythrol tetranitrate suggests that these 2 drugs, despite clinical evidence to the contrary, should be equally effective in preventing attacks of angina pectoris. This proved to be true when the drugs were administered by the same route. Thus, erythrol tetranitrate when administered sublingually (instead of being swallowed, as is the custom) behaves like nitroglycerin and is one of the most effective vasodilators available. Conversely, nitroglycerin when swallowed (instead of being taken sublingually, as is the custom) is ineffective and erratic in activity. A similar striking increase in vasodilating action on sublingual administration is seen also with mannitol hexanitrate and triethanolamine trinitrate and to a lesser extent with pentaerythritol tetranitrate but not with sodium nitrite. The prolonged effect of erythrol tetranitrate, when administered sublingually or in the buccal pouch, makes it particularly valuable in the clinical management of patients with angina pectoris.