Knowledge, Attitude and Practice of Physicians in Appropriate Prescription of Organic Nitrates in Iran

Organic nitrates are commonly used in angina pectoris and ischemic cardiomyopathy. In order to optimize their effectiveness and patient convenience, several aspects must be observed. Adequate doses, suitable dosage forms and asymmetric pattern of usage to prevent the nitrate tolerance are some factors that a physician must be familiar with. The objective of the present study was to define the pattern of organic nitrates administration by Iranian physicians. To investigate the pattern of organic nitrates prescription, 42000 written prescriptions by physicians were reviewed and 345 of those which had at least one nitrate drug in, were considered. Also, a questionnaire was designed and the responses of 54 physicians were collected. Results showed that nitroglycerine 6.4 mg was the most and isosorbide dinitrate 40 mg was the least prescribed oral forms. No spray and topical forms had been prescribed. The most written dosing frequency was three times a day. Asymmetric pattern of usage had not been observed in prescriptions. Results of questionnaires showed that about 80% of physicians were familiar with nitrate tolerance phenomenon but only about 20% of them knew the appropriate way to prevent it. More than half of the respondents believed that the appropriate dose for ischemic heart disease was higher than that in congestive heart failure while it was claimed that the opposite was right. These findings suggest that more efforts must be carried out to increase the knowledge, attitude and practice of Iranian physicians regarding the appropriate dosing and administration of organic nitrates.