Isosorbide Dinitrate Solution Spray in Exercise-Induced Angina Pectoris

Abstract

The effects of a new formulation of isosorbide dinitrate (ISDN) spray (1.25 and 2.5mg) on exercise-induced anginal symptoms and ischaemic ST-segment changes were studied in a randomised, double-blind, placebo-controlled, crossover study in 20 patients with stable angina pectoris. ISDN spray at both doses reduced ST-segment depression at the highest common workload by 64% (p < 0.001), whereas there was only a slight reduction after administration of placebo (18%). The time to onset of anginal symptoms was increased by 62% with ISDN 1.25mg and 59.5% with ISDN 2.5mg (both p < 0.001) compared with 9% with placebo (p < 0.05). The time to onset of ST depression was also prolonged by 27% and 29% with ISDN 1.25mg and 2.5mg, respectively (both p < 0.001), compared with 5% with placebo (p < 0.05). The time to maximal workload, maximal workload stage and work capacity were also significantly increased by ISDN spray at both doses. There were no statistically significant differences between the effects of ISDN 1.25mg and ISDN 2.5mg, but both dosages were significantly superior to placebo in comparisons of changes in the parameters above. There were no significant changes in heart rate, blood pressure and the double product either at rest or during exercise; there was, however, a small reduction in systolic blood pressure at rest prior to exercise in ISDN-treated patients. There were no serious adverse events. It is concluded that ISDN spray is an effective and safe treatment for the prevention of exercise-induced angina pectoris.