What are the sublingual doses of Nitroglycerin (glyceryl trinitrate)?

From the Guidelines

Nitroglycerin sublingual tablets are typically administered at a dose of 0.3 to 0.6 mg up to 1.5 mg for acute angina relief, as recommended by the American College of Cardiology Foundation/American Heart Association task force on practice guidelines 1. The patient should place the tablet under the tongue and allow it to dissolve completely without swallowing.

Key Considerations

• This dose can be repeated every 5 minutes for a maximum of 3 doses in a 15-minute period if chest pain persists, as suggested by the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction 1.
• If chest pain continues after 3 doses, the patient should seek emergency medical attention immediately.
• Patients should be seated when taking nitroglycerin to prevent falls from potential hypotension.
• Common side effects include headache, dizziness, and flushing.
• Nitroglycerin works by relaxing vascular smooth muscle, causing vasodilation which reduces cardiac preload and afterload, thereby decreasing myocardial oxygen demand and improving blood flow to ischemic areas of the heart.

Storage and Replacement

• The medication should be stored in its original container, away from heat and moisture, as it loses potency over time.
• Patients should replace their nitroglycerin supply every 3-6 months, even if unused, to ensure effectiveness when needed.

Patient Education

• Before hospital discharge, patients with non-ST-elevation acute coronary syndromes should be informed about symptoms of worsening myocardial ischemia and MI and should be given verbal and written instructions about how and when to seek emergency care for such symptoms 1.
• Patients should be educated about modification of cardiovascular risk factors to prevent future episodes of angina.

From the FDA Drug Label

Nitroglycerin sublingual tablets are supplied in 3 strengths (0.3 mg, 0.4 mg, and 0.6 mg) The sublingual doses of Nitroglycerin are:

• 0.3 mg
• 0.4 mg
• 0.6 mg 2 2

From the Research

Sublingual Doses of Nitroglycerin

• The sublingual dose of nitroglycerin is typically in the range of 0.3 to 0.4 mg, which may be repeated after 3 to 5 minutes if pain persists 3.
• There is no specific mention of a higher dose of sublingual nitroglycerin in the provided studies, but it is mentioned that higher doses of nitrates may be required for ischemia control during the initial management of unstable angina 4.
• The studies primarily discuss the use of nitroglycerin in the management of angina pectoris, but do not provide a detailed analysis of the optimal sublingual dose 5, 6.
• It is worth noting that the use of higher doses of nitrates, such as sublingual isosorbide dinitrate, may be effective in some patients, but this is not directly related to the sublingual dose of nitroglycerin 7.

Administration and Efficacy

• Sublingual nitroglycerin is effective in providing rapid relief of angina symptoms and can be used to complement anti-anginal therapy 6.
• The sublingual spray formulation of nitroglycerin may have several clinical advantages compared to tablet formulations, including a lower incidence of headache and superiority in terms of therapeutic action and time to onset 6.
• The optimal dosage and route of administration of nitrates, including nitroglycerin, may vary depending on the individual patient and the specific clinical scenario 4.