INTRAVENOUS MOLSIDOMINE IN HEART-FAILURE - PART II - HEMODYNAMIC ACTION IN PATIENTS TOLERANT TO NITROGLYCERIN

Objective of the present study was to investigate the hemodynamic resp onse to molsidomine in nitrate tolerance state. Development of nitrate tolerance was observed during intravenous nitroglycerin treatment (10 mg/h) in 13 out of 16 patients (5 women, 11 men; median age 62 years, range 53-71 years) with chronic heart failure (NYHA stage II-III). Th e criterion applied was an at least 50% loss of efficacy with regard t o the pulmonary capillary wedge pressure as compared to the maximum ef fect of nitrate, The effect of molsidomine (10 mg i.v. over 15 min) wa s determined in a blank test, 10 mg molsidomine were administered intr avenously again in the stage of clinically manifest nitrate tolerance, Compared to the effect of molsidomine on its own, significantly more pronounced reductions of the mean pulmonary capillary wedge pressure ( 32% as compared to 15%) and of the mean pulmonary arterial pressure (3 5% as compared to 22%) and a significantly greater increase of the car diac output (26% as compared to 7%) were measured (p < 0.05 each), Mai ntaining nitroglycerin infusion, the effect of molsidomine (at least 9 0% of the maximum effect) lasted for 147 (130/182) minutes (median, 25 %/75% percentiles), The baseline values (at least 75% decline in the e ffect of molsidomine) were only reached after 363 (319/412) minutes (m edian, 25%/75% percentiles). Conclusion: The results document a favora ble hemodynamic effect of molsidomine in nitrate tolerance, Thus molsi domine should be considered during longterm infusion of NO donors.