Isosorbide mononitrate may benefit patients with acute MI With associated heart failure Although early oral administration of isosorbide dinitrate has been shown to reduce mortality in patients with acute myocardial infarction (MI) + high left ventricular filling pressures, this drug undergoes extensive first pass metabolism. Therefore, the effect of oral isosorbide mononitrate (an isosorbide dinitrate metabolite which does not undergo first pass metabolism) on mortality of patients with a provisional diagnosis of acute MI was investigated in a double-blind, muIticentre trial. Patients randomly received oral isosorbide mononitrate ('Elantan') 20-40mg initially, followed by 80 mg/day for 2 days, then 60 mg! day for I day, then 40 mg/day for 2 days (n = 184) or placebo (176). Compared with placebo, isosorbide mononitrate significantly reduced systolic and diastolic BP by 9 and 6%, and by 6 and 5% at 6 and 12 hours, respectively. Isosorbide mononitrate did not significantly reduce overall mortality, however, a trend was observed; isosorbide mononitrate recipients with associated heart failure had a 39% lower mortality than placebo recipients with heart failure at day 5, and the mortality of isosorbide mononitrate recipients without heart failure or peripheral hypoperfusion was 2 and 1.5 times higher than placebo recipients at day 5 and 6 months, respectively. The mean time from onset of pain to treatment was significantly longer (approximately twice) in nonsurviving compared with surviving isosorbide mononitrate recipients with heart failure, respectively. During the first 48 hours, significantly more isosorbide mononitrate recipients required lidocaine [lignocaine] (23 vs II %) and significantly less isosorbide mononitrate recipients required IV nitrates (15 vs 25%) compared with placebo recipients. There was a similar incidence of patient withdrawal from both treatment groups, with the most common adverse effects being hypotension and headache. 'We recommend nitrate therapy for QCute MI patients with heart failure, but suggest that the most appropriate nitrate preparation has yet to be identified.' Fillgcrald U. Bennett ED. The effects of oral isosorbide 5 mononitrate on monality following acute myocardial infarction: a multicentre study. European Hean Journal II: 120-126. Feb 1990 .lI" ISSN 0I56-170J/90/0601-OOOJ/flStJl.OO/O e Ad;s lI'temat;om Ltd INPHARMA@ 1 J"" 1990 15 -

Isosorbide mononitrate may benefit patients with acute MI

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Page 1: Isosorbide mononitrate may benefit patients with acute MI

Isosorbide mononitrate may benefit patients with acute MI With associated heart failure

Although early oral administration of isosorbide dinitrate has been shown to reduce mortality in patients with acute myocardial infarction (MI) + high left ventricular filling pressures, this drug undergoes extensive first pass metabolism. Therefore, the effect of oral isosorbide mononitrate (an isosorbide dinitrate metabolite which does not undergo first pass metabolism) on mortality of patients with a provisional diagnosis of acute MI was investigated in a double-blind, muIticentre trial. Patients randomly received oral isosorbide mononitrate ('Elantan') 20-40mg initially, followed by 80 mg/day for 2 days, then 60 mg! day for I day, then 40 mg/day for 2 days (n = 184) or placebo (176).

Compared with placebo, isosorbide mononitrate significantly reduced systolic and diastolic BP by 9 and 6%, and by 6 and 5% at 6 and 12 hours, respectively. Isosorbide mononitrate did not significantly reduce overall mortality, however, a trend was observed; isosorbide mononitrate recipients with associated heart failure had a 39% lower mortality than placebo recipients with heart failure at day 5, and the mortality of isosorbide mononitrate recipients without heart failure or peripheral hypoperfusion was 2 and 1.5 times higher than placebo recipients at day 5 and 6 months, respectively. The mean time from onset of pain to treatment was significantly longer (approximately twice) in nonsurviving compared with surviving isosorbide mononitrate recipients with heart failure, respectively. During the first 48 hours, significantly more isosorbide mononitrate recipients required lidocaine [lignocaine] (23 vs II %) and significantly less isosorbide mononitrate recipients required IV nitrates (15 vs 25%) compared with placebo recipients. There was a similar incidence of patient withdrawal from both treatment groups, with the most common adverse effects being hypotension and headache.

'We recommend nitrate therapy for QCute MI patients with heart failure, but suggest that the most appropriate nitrate preparation has yet to be identified.' Fillgcrald U. Bennett ED. The effects of oral isosorbide 5 mononitrate on monality following acute myocardial infarction: a multicentre study. European Hean Journal II: 120-126. Feb 1990 .lI"

ISSN 0I56-170J/90/0601-OOOJ/flStJl.OO/O e Ad;s lI'temat;om Ltd INPHARMA@ 1 J"" 1990

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