Angina: When Nitroglycerin Is Not the Answer

08/08/08 Treatment Options

If you have weekly or less than weekly angina attacks, your doctor may have told you to take nitroglycerin when an attack happens or before doing anything likely to trigger chest pain like exercise.

If attacks are more frequent, the next course of medical treatment is either a longer-acting nitrite or a beta blocker. Nitrites and beta blockers are usually the first line of treatment for stable (chronic) angina and work very well in people whose angina is brought on by exercise.

Long-acting nitrites can be given as a patch that releases the medicine through the skin, or an oral nitrite that lasts from three to eight hours. The downside of long-lasting nitrites is that the body develops a tolerance to them, rendering them ineffective. Most people need an eight- to 12-hour period when they are nitrite-free, often during sleep. However, during their “nitrite break,” some patients experience “rebound angina” and need other medications to control this.

Side effects of nitrites include lightheadedness, headache, flushing, and elevated blood pressure. Older people may become faint, especially during very hot weather. Alcohol can increase side effects. The combination of nitrites and medicines for erectile dysfunction (ED) can be extremely dangerous. Men taking nitrites should be sure the doctor treating their ED knows their complete medical history.

The other class of medication usually prescribed for angina is a beta blocker. These drugs work by interfering with the nervous system’s stimulation of the heart. This lowers the heart rate, blood pressure, and contractions of the heart so it doesn’t have to work as hard to pump blood.

Beta blockers, usually taken once a day, have been shown to increase survival and prevent a second heart attack in patients who have already had one. There are many beta blockers on the market. Each works slightly differently and the dosage needs to be fine-tuned for each patient.

Most people do not experience side effects, but there are some including circulatory problems, ED in men, and breathing problems which is why these drugs are not prescribed for patients with lung disease.

There is also a chronic angina clinical trial accepting participants. This trial will evaluate the effectiveness of an investigational treatment for chronic angina in women. Click here for more information.

Mari S. Gold is has written for The New York Times, American Profile, Relish Magazine, TravelSmart, Indianapolis Monthly, and numerous e-zines. An avid cook and foodie, she contributes restaurant reviews to Zagat Guides and The Vermont News Guide, and is working on a young adult novel with a food theme. Married with grown children and two cats, she divides her time between New York City where she is director of communications for a major health care organization, and Dorset, Vermont.