Patient Compliance with Once-Daily and Twice-daily Oral Formulations of 5-Isosorbide Mononitrate: A Comparative Study

This study compares patient compliance with once- and twice-daily formulations of 5-isosorbide mononitrate. A total of 31 patients (20 men and 11 women) with stable angina pectoris were randomized to receive either 60 mg 5-isosorbide mononitrate in a controlled release formulation once daily, or 20 mg 5-isosorbide mononitrate twice daily. The results indicated that compliance assessed using the electronic Medication Event Monitoring System (MEMS®) was better with the once-daily than with the twice-daily formulation; patients on the once-daily regimen performed better with respect to the total number of bottle openings, the number of openings per day, the timing of openings and the intervals between openings. The apparently superior compliance with the once-daily regimen appeared to be reflected in better efficacy; patients on the once-daily regimen experienced fewer angina attacks (a mean of 1.7 per 7 days, compared with 3.3 per 7 days for patients on the twice-daily regimen) and used fewer nitroglycerin tablets than those on the twice-daily regimen.

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Patient Compliance and Therapeutic Coverage: Amlodipine versus Nifedipine (Slow-Release) in the Treatment of Angina Pectoris

Journal of International Medical Research ◽

10.1177/030006059402200505 ◽

1994 ◽

Vol 22 (5) ◽

pp. 278-286 ◽

Cited By ~ 6

Author(s):

J-M R Detry ◽

P Block ◽

G De Backer ◽

J-P Degaute ◽

R Six ◽

...

Keyword(s):

Angina Pectoris ◽

Monitoring System ◽

Patient Compliance ◽

Slow Release ◽

Treatment Time ◽

Electronic Device ◽

Time Interval ◽

Event Monitoring ◽

Once Daily ◽

Correct Dose

Patient compliance with therapy is often poor and overestimated by the treating physician; it is particularly important in cardiovascular diseases such as hypertension and angina pectoris. Compliance was studied in an open parallel study in out-patients with stable angina pectoris, given either amlodipine (5 mg, once daily) or slow-release nifedipine (20 mg, twice daily) for 12 weeks. Compliance was assessed using pill counting and using an electronic device, the medication event monitoring system, to record the time and date of each opening and closure of the pill container. There was no difference between the two groups in pill count or taking ‘in compliance’ (the percentage of prescribed doses taken as indicated by the monitoring system). Compliance was significantly better ( P < 0.001) with amlodipine, however, for ‘correct dosing’ (the percentage of days on which the correct dose was taken) and for ‘timing compliance’ (the percentage of doses taken at the prescribed time interval after the last dose). ‘Therapeutic coverage’ (the estimated proportion of treatment time for which the drug was active) was also significantly better for amlodipine ( P < 0.001). There was no difference in reported side-effects between the two therapies.

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Pharmacokinetics and additional anti-ischaemic effectiveness of amlodipine, a once-daily calcium antagonist, during acute and long-term therapy of stable angina pectoris in patients pre-treated with a beta-blocker

European Heart Journal ◽

10.1093/eurheartj/14.11.1531 ◽

1993 ◽

Vol 14 (11) ◽

pp. 1531-1535 ◽

Cited By ~ 8

Author(s):

G. LEHMANN ◽

G. REINIGER ◽

A. BEYERLE ◽

W. RUDOLPH

Keyword(s):

Calcium Antagonist ◽

Angina Pectoris ◽

Beta Blocker ◽

Stable Angina ◽

Term Therapy ◽

Stable Angina Pectoris ◽

Once Daily ◽

Long Term Therapy

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Efficacy and Tolerability of Once-Daily Sustained-Release and Conventional Diltiazem in Patients with Stable Angina Pectoris

Clinical Drug Investigation ◽

10.2165/00044011-199713020-00001 ◽

1997 ◽

Vol 13 (2) ◽

pp. 59-65

Author(s):

B. Debrégeas ◽

J. Duchier

Keyword(s):

Angina Pectoris ◽

Sustained Release ◽

Stable Angina ◽

Stable Angina Pectoris ◽

Once Daily

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Efficacy and safety of once-daily monotherapy with coat-core nisoldipine in patients with stable angina pectoris: Dose response studies

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(96)80750-9 ◽

1996 ◽

Vol 27 (2) ◽

pp. 131

Author(s):

Udho Thadani

Keyword(s):

Angina Pectoris ◽

Dose Response ◽

Stable Angina ◽

Efficacy And Safety ◽

Stable Angina Pectoris ◽

Once Daily

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Compliance as a Factor in the Development of Nitrate Tolerance: A Patient Investigation

Journal of International Medical Research ◽

10.1177/030006059302100106 ◽

1993 ◽

Vol 21 (1) ◽

pp. 51-57 ◽

Cited By ~ 2

Author(s):

P Löfdahl

Keyword(s):

Angina Pectoris ◽

Nitrate Concentration ◽

Nitrate Tolerance ◽

Isosorbide Mononitrate ◽

Dosing Regimen ◽

Once Daily ◽

Telephone Interviews ◽

The Times ◽

Plasma Nitrate ◽

Long Acting

Telephone interviews were conducted to establish the prescribing instructions given by experienced physicians to patients with angina pectoris treated with long-acting nitrates. In addition, the times of day when doses were taken were recorded. The aim of the study was to determine whether or not an asymmetric dosing regimen was being followed by the patients. The majority (62.7%) of patients were being treated with 5-isosorbide mononitrate taken orally twice daily. All but two took the correct number of tablets, but more than 50% of these patients were not taking the second tablet at the correct time to achieve the recommended 6 − 8-h period during which the plasma nitrate concentration was sufficiently low to avoid nitrate tolerance. Possible explanations for the incorrect use of the prescribed drug may be that the patients did not understand the physician's instructions and did not appreciate the importance of rigidly adhering to these instructions. A more satisfactory approach, with improved patient compliance, may be a once-daily dosing regimen.

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