To the Editor: The two excellent studies on the development and reversal of nitrate tolerance, by Packer et al.1 and May et al.2 (Sept. 24 issue), both conclude — even in their titles — that N-acetylcysteine may reverse pharmacologic tolerance to nitroglycerin. We doubt, however, whether this conclusion can be supported by the published results. Both papers present evidence for the enhancement of nitrate effects in tolerant subjects, but the relative magnitude of N-acetylcysteine effects at the beginning of nitrate therapy and after the development of tolerance has not been investigated. Because the same interaction between N-acetylcysteine.
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