Ischaemea and sorbitrate for senior citizens

I am 66 year old male from India.I am told that i had Ischamea in the year 1977 without any symptoms. I have taken an ECG just like that. My doctor revealed this. After that i hve taken some medicines for a period of 6 months. this happend after my fathers sudden death due to MI, when i was under deep depressiona dn fear for aperiod of 4 months .i.e from july to Nov 77.After that till this time ther is no problem and i have never visited a Cardiologist also. I had little BP which is well undercontrol with medicines.

I am told that Doctors in USA prescribe Sorbitrate to the Ischaemic patients and also for senior citizens.Is it true. If so will you suggest me to keep sorbitrate, if so what is the minima dosage i have to kept.

Please excuse me for having taken your valuable time.

Have a good day

[kenkeith]

I only take isosorbide prior to a workout, and nitro when engaged in an activity that brings on angina.  I understand  your doctors are suggesting taking isosorbide daily as aschemia does not always produce angina even though the heart cells are not getting sufficient blood supply.  This can lead to a silent heart attack so the medication is recommended continuously whether there is angina or not and older people in general are likely to have a silent heart attack.

But there is a risk of developing a tolerance. "Some persons taking nitroglycerin or isosorbide mononitrate may find that it loses efficacy over time. This is because the body adapts to the drug, a process known as developing tolerance. One study found that taking 2 grams three times daily of vitamin C can decrease this effect when nitroglycerin patches are simultaneously used.2 Similar benefits have been confirmed in another study.3 However, it should be noted that it is also possible to avoid tolerance to these drugs by simply changing the dosing schedule. People taking ISMN or nitroglycerin should talk with their pharmacists about avoiding drug tolerance.

I change dosing schedules!

[isweetfellow]

My question is whether we the senior citizens should keep sorbitrate handy if so what is the minimal dosage. I did not mean that i am taking sorbitrate daily.

[kenkeith]

I attempted to explain to you, on another identical post as well, isosorbide is generic for sorbitrate and is taken to PREVENT angina due to ischemia.  If you want medication handy in the event you are experiencing angina, nitro is fast acting and within seconds or so there is relief.  Doesn't make sense to keep sorbitrate handy as there is not immediate relief.

If you are going to more active than usual and the activity may bring on angina then you may want to take sorbitrate or the less expensive generic, isosorbide.  Follow your doctor's instructions.

If you are diabetic and/or your doctor believes you may experience damaging ischemia without angina that could cause an MI, he/she may want you to take the medication daily. There are individuals that don't experience angina with ischemia and have a MI as a consequence.  A doctor may suggest as a precaution a senior citizen take a nitrate daily to avoid any damaging ischemia.

Some doctors may prescribe isosorbide 10 mg, twice a day, and can be increased.  It is likely it would be increased later as a patient can develop some tolerance.  My regimen for last 4 years is as posted, and have not had any increase in dosage.  

[chrisr]

Since I use Nitro patches regularly I would be grateful to obtain the references for the studies you mentioned about the effects of Vit C in decreasing the developing tolerance of continuous nitroglycerin use.
Thanks,
ChrisR

[kenkeith]

Nitrate Medications for heart disease - The combination of vitamin C with nitroglycerin, isosorbide dinitrate, or isosorbide mononitrate reduces the occurrence of nitrate tolerance. Nitrate tolerance is when the body builds up a tolerance to the medicine so that it no longer has its desired effect. People taking nitrate-containing medications generally follow a 12 hours on, 12 hours off schedule to avoid this tolerance. Studies suggest that taking vitamin C along with nitrate medications may reduce the development of this tolerance.

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Vitamin C
Some persons taking nitroglycerin or isosorbide mononitrate may find that it loses efficacy over time. This is because the body adapts to the drug, a process known as developing tolerance. One study found that taking 2 grams three times daily of vitamin C can decrease this effect when nitroglycerin patches are simultaneously used.2 Similar benefits have been confirmed in another study.3 However, it should be noted that it is also possible to avoid tolerance to these drugs by simply changing the dosing schedule. People taking ISMN or nitroglycerin should talk with their pharmacists about avoiding drug tolerance
References:
1. Svendsen JH, Klarlund K, Aldershvile J, Waldorff S. N-acetylcysteine modifies the acute effects of isosorbide-5-mononitrate in angina pectoris patients evaluated by exercise testing. J Cardiovasc Pharmacol 1989;13:320–3.

2. Watanabe H, Kakihana M, Ohtsuka S, Sugishita Y. Randomized, double-blind, placebo-controlled study of the preventive effect of supplemental oral vitamin C on attenuation of development of nitrate tolerance. J Am Coll Cardiol 1998;31:1323–9.

3. Bassenge E, Fink N, Skatchkov M, Fink B. Dietary supplement with vitamin C prevents nitrate tolerance. J Clin Invest 1998;102:67–71.

4. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antianginal Agents, Nitrates. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1992, 143e.

5. Kosoglou T, Kazierad DJ, Schentag JJ, et al. Effect of food on the oral bioavailability of isosorbide-5-mononitrate administered as an extended-release tablet. J Clin Pharmacol 1995;35:151–8.

6. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antianginal Agents, Nitrates. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1992, 143e.

7. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antianginal Agents, Nitrates. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr