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Angina - stable - Management
What adverse effects are associated with nitrates, and how can they be managed?
- Transient hypotension that manifests as dizziness, weakness, and palpitations has been reported with isosorbide mononitrate. Hypotension often presents as postural hypotension occurring shortly after drug administration.
- Headache occurs in more than 60% of people receiving glyceryl trinitrate (GTN) and 25–40% of people receiving isosorbide dinitrate or mononitrate. In addition, GTN may precipitate a migraine headache in people with a history of migraine.
- Tolerance to headache usually occurs over 1–2 weeks, although 10–20% of people cannot tolerate nitrates because of headache.
- To minimize the risk of headache, start at a low dose (for example 10 mg twice a day) and titrate up.
- Burning, stinging, or tingling of the mouth is experienced by some people taking sublingual GTN tablets.
- If this is bothersome, consider using a lower dose of GTN tablets, or a GTN sublingual spray.
In depth
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