Nitric oxide donor drugs

Research over the past 20 years has identified endogenous nitric oxide (NO) as a key messenger molecule in the cardiovascular, nervous and immune systems. Research to date has centered on the cardiovascular system in which reduced bioavailability of NO is implicated in a range of diseases. Delivery of exogenous NO is an attractive therapeutic option in the treatment of cardiovascular disease. Organic nitrates were first used to relieve the symptoms of angina over a century ago, long before the identification of NO as an endogenous messenger. It is now recognized that the beneficial effects of organic nitrates are mediated by NO and, despite limitations, they remain the most commonly used NO donor drugs in cardiovascular medicine. Recently, a range of novel NO donor drugs have evolved as potential alternatives to conventional nitrates. This review describes the chemical and biological properties of the major classes of NO donor drugs and outlines their therapeutic potential, primarily in the treatment of cardiovascular disease.