FDA recommends change in chest pain treatment

November 22, 1996
Web posted at: 9:50 p.m. EST

From Correspondent Linda Ciampa

(CNN) -- For a long time, doctors treated angina, or recurring chest pain, with nitrate pills and patches. But now the Food and Drug Administration is recommending a change in the way nitrates are prescribed to assure that the drugs keep working.

"All patients who are on either nitroglycerin patches or oral nitrates should be aware that they need a washout period," said Basil Margolis of St. Joseph's Hospital. "If they take it consistently around the clock, they will become tolerant or immune to it."

A survey -- paid for by a pharmaceutical company that makes a new type of nitrate -- finds that eight out of 10 doctors who regularly prescribe nitrates are unaware of the changes in the FDA's recommendations.

"Doctors have been using the dinitrates for so long they don't read the labels," said Dr. Stephen Glasser, University of South Florida College of Medicine. "For a new drug, you would read the label. For a drug you've been using, it doesn't even strike you that you should read it unless you know there's been a change."

Nitrate tablets were introduced almost 40 years ago when drugs came to market much easier than they do today. The tolerance issue may have taken too long to surface because there was less rigorous testing required then and because of what patients learned to do.

"What most patients do with angina is -- they learn to live below a level of exertion that producers angina," said Glasser.

The newer mononitrates work better than the older dinitrates because they're taken just once a day, making it harder to build up an immunity.

But there is a concern: "It's probably a slightly more sophisticated version, but they both work just as well -- the big difference being that the newer mononitrates are very, very much more costly than the older nitrates."

Several cardiologists agree that the older less expensive dinitrates will work just as well for chest pain -- as long as doctors prescribe them according to current FDA recommendations.

 

Related stories:

• New drug more effective than aspirin in reducing some heart attacks - October 31, 1996

Related sites:

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• American Heart Association
• The Heart

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