Intravenous nitroglycerin for the treatment of angina at rest unresponsive to standard nitrate therapy

Am J Cardiol. 1983 Mar 1;51(5):694-8. doi: 10.1016/s0002-9149(83)80117-9.


Thirty-five patients who had angina at rest that was unresponsive to standard therapy comprised of oral or topical nitrates and beta-blocking drugs were treated with a continuous infusion of intravenous nitroglycerin (IVNTG). The infusion was started at 10 micrograms/min and increased by 10 micrograms/min increments every 5 minutes until an infusion rate of 50 micrograms/min was reached. After each episode of rest angina, the infusion was increased by 50 micrograms/min in the same stepwise manner. Data from a 24-hour baseline control period were compared with those from a 24-hour IVNTG endpoint period at which time the highest IVNTG infusion rate was administered. The average IVNTG infusion rate was 140 +/- 15 micrograms/min. With IVNTG therapy, the number of episodes of angina at rest decreased from 3.5 +/- 0.4 to 0.3 +/- 0.1, sublingual nitroglycerin use decreased from 1.9 +/- 0.3 to 0.4 +/- 0.1 mg/day, and morphine sulfate administration decreased from 5.5 +/- 1.3 to 0.4 +/- 0.2 mg/day (all p less than 0.001). When each patient's response on the endpoint day was analyzed, 25 were defined as complete (no rest angina), 8 as partial (greater than 50% decrease in the number of episodes/day from control values), and 2 as nonresponders. No significant drug-induced adverse effects occurred. IVNTG appears to be effective therapy for angina at rest refractory to standard oral and topical medications.

MeSH terms

  • Adult
  • Aged
  • Angina Pectoris, Variant / diagnosis
  • Angina Pectoris, Variant / drug therapy*
  • Coronary Vasospasm / drug therapy*
  • Female
  • Humans
  • Infusions, Parenteral
  • Isosorbide Dinitrate / therapeutic use
  • Male
  • Middle Aged
  • Nitroglycerin / administration & dosage*
  • Nitroglycerin / adverse effects
  • Nitroglycerin / therapeutic use


  • Nitroglycerin
  • Isosorbide Dinitrate