Some issues concerning transdermal nitroglycerin patches

There is sufficient evidence to suggest that the duration of action of transdermal nitroglycerin patches is between 20 and 26 hours, as measured by exercise testing. At 24 hours there may be some patient variability, particularly with lower doses; however, the majority of patients show an increase in exercise time at 24 hours. In studies of the same patients, higher doses of transdermal nitroglycerin resulted in greater increases in exercise time, suggesting that higher doses may be more effective and that titration to higher doses is desirable. However, there is insufficient information from the chronic studies reported in the literature to draw any definitive conclusions. In the only crossover comparative studies reported in the literature to date, transdermal nitroglycerin appears to be as effective as isosorbide dinitrate and nifedipine. While transdermal nitroglycerin patches appear to be an effective mode of therapy, further studies are needed to confirm these findings.