Angispan TR is NOT Glyceryl Nitrate
Angispan TR (diltiazem) is not the same as glyceryl nitrate (nitroglycerin). Angispan TR contains diltiazem, which is a calcium channel blocker belonging to the benzothiazepine class, while glyceryl nitrate is a nitrate vasodilator with a completely different mechanism of action. 1
Understanding Diltiazem (Angispan TR)
Diltiazem is a non-dihydropyridine calcium channel blocker with the following characteristics:
- Belongs to the benzothiazepine class of calcium channel blockers 1
- Blocks calcium influx through L-type calcium channels, causing coronary and peripheral vasodilation 1
- Has moderate effects on heart rate and atrioventricular conduction 1
- Produces less peripheral arterial vasodilation compared to dihydropyridine calcium channel blockers like nifedipine 1
- Has significant direct effects on atrioventricular conduction and heart rate 1
Understanding Glyceryl Nitrate (Nitroglycerin)
Glyceryl nitrate, commonly known as nitroglycerin, has distinctly different properties:
- Acts as a nitrate vasodilator that releases nitric oxide 1
- Primarily causes venodilation, reducing preload 1
- Can develop tolerance with continuous use 1
- Often causes headache as a side effect due to vasodilation 1
- Typically administered sublingually, transdermally, or intravenously for acute coronary syndromes 1
Clinical Applications: Key Differences
Diltiazem (Angispan TR):
- Effective in stable angina, unstable angina, and vasospastic angina 1, 2
- Used for rate control in atrial fibrillation 1
- May be beneficial in hypertension management 2
- Can be used in patients with contraindications to beta-blockers 1
- Particularly useful in vasospastic angina along with other calcium channel blockers 1, 3
Glyceryl Nitrate:
- First-line treatment for acute angina attacks 1
- Used intravenously in acute coronary syndromes 1
- Requires nitrate-free intervals to prevent tolerance 1
- Less effective for long-term management due to tolerance development 1
Potential Confusion Points
The confusion between these medications may arise because:
- Both are used in the management of angina, though through different mechanisms 1
- Both can be administered in various formulations (oral, intravenous) 1
- They are sometimes used together in combination therapy for angina 1, 3
Clinical Considerations
When selecting between these medications:
- Diltiazem is preferred when heart rate control is needed along with anti-anginal effects 1
- Glyceryl nitrate is preferred for rapid relief of acute angina symptoms 1
- Diltiazem should be avoided in patients with severe left ventricular dysfunction or heart failure 1
- Glyceryl nitrate should not be used with phosphodiesterase inhibitors like sildenafil due to risk of severe hypotension 1
Conclusion
Angispan TR contains diltiazem, a calcium channel blocker with vasodilatory and rate-controlling properties. It is pharmacologically and therapeutically distinct from glyceryl nitrate (nitroglycerin), which is a nitrate vasodilator. These medications have different mechanisms of action, side effect profiles, and specific clinical applications in cardiovascular disease management.