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January 10, 1977

Nitrates and Glaucoma

JAMA. 1977;237(2):117. doi:10.1001/jama.1977.03270290017002

To the Editor.—  We felt Dr Reichek's recent review "Long-Acting Nitrates in the Treatment of Angina Pectoris" (236:1399, 1976) was an excellent survey of the clinical pharmacology of these compounds. However, he raised one point with which we cannot fully agree and which we feel the recent literature does not support.In the discussion on toxicity of the nitrates, Dr Reichek states, "Nitrates raise intraocular pressure and are relatively contraindicated in patients with glaucoma." This assertion is probably based on similar statements in a number of older textbooks of pharmacology, which themselves are based on rather tenuous experiments performed many years ago. These suggested that intraocular pressure could occasionally be raised slightly for a short period of time by amyl nitrite inhalation. Over a period of years, this limited and inconsistent finding was extrapolated into a pharmacological legend that was perpetuated in textbooks and the manufacturers' literature.The history of