La tolerancia los nitratos: Un problema práctico
DOI:
https://doi.org/10.51481/amc.v39i2.603Palabras clave:
nitratos, tolerancia, cardiopatía isquémica, insuficiencia cardíaca, angina de reboteResumen
Justificación y. objetivo: Los nitratos son fármacos extensamente usados en el tratamiento de la cardiopatía isquémica y de la insuficiencia cardíaca congestiva. Una de sus limitaciones es el rápido desarrollo de tolerancia a sus efectos hemodinámicos.
El objetivo del presente artículo es revisar algunas evidencias de la existencia del fenómeno de la tolerancia a los nitratos, los posibles mecanismos involucrados en su origen, sus implicaciones clínicas y las estrategias prácticas para prevenirla. Métodos: Se realizó una revisión bibliográfica sobre el tema en revistas médicas de reconocido prestigio y a través de Medline.
La evidencia indica que la administración continua de nitratos resulta en el desarrollo a corto plazo de tolerancia a sus propiedades vasodilatadoras periféricas y coronarias, ocasionando una reducción marcada de sus efectos hemodinámicos y antiisquémicos. La causa del problema parece ser multifactorial.
La terapia intermitente, permitiendo un período de varias horas al día sin fármaco, es la estrategia más recomendada en la actualidad para prevenir la tolerancia a los nitratos, a pesar de que en ocasiones puede asociarse al riesgo de provocar una exacerbación de los síntomas por efecto rebote.
Conçlusión: Conocer la existencia del fenómeno de la tolerancia a los nitratos es indispensable para una utilización más racional y efectiva de estos valiosos fármacos.
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