From the Guidelines
Nitrolingual (nitroglycerin) should not be diluted, as it is a sublingual spray that comes in a pre-measured dose form and is designed to be administered directly under the tongue without any modification. The standard dose is 1-2 sprays (0.4-0.8 mg) under the tongue when experiencing chest pain, which can be repeated every 5 minutes for up to 3 doses, as recommended by the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 1. If chest pain persists after 3 doses, immediate medical attention should be sought. Diluting Nitrolingual would alter its concentration and absorption rate, potentially reducing its effectiveness in treating angina or other cardiac conditions.
Key Points to Consider
- The medication works by relaxing blood vessels, improving blood flow to the heart, and reducing the heart's workload.
- Nitrolingual should be stored at room temperature, away from heat and light, with the canister kept tightly closed when not in use.
- The spray should be primed with 5-10 sprays when new or if not used for more than 6 weeks.
- Patients should sit down before administration to avoid dizziness from the blood pressure-lowering effects, as noted in the guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction 1.
- It is essential to follow the recommended dosage and administration guidelines to ensure the safe and effective use of Nitrolingual, as supported by the evidence from the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 1.
From the Research
Nitrolingual (Nitroglycerin) Dilution
- The provided studies do not directly mention the dilution for Nitrolingual (nitroglycerin) 2, 3, 4, 5, 6.
- However, the studies discuss the dosage and administration of nitroglycerin and other nitrates for angina pectoris treatment.
- According to the study published in 1986, nitroglycerin lingual spray delivered 0.2,0.4, and 0.8 mg of nitroglycerin, and the dose of 0.4 or 0.8 mg appeared to be most effective and similar to 0.4 mg of sublingual GTN 5.
- Another study published in 1998 discussed the optimal dosage and mode of administration of nitrates for unstable angina, but did not provide information on the dilution of Nitrolingual (nitroglycerin) 6.
Administration and Dosage
- The studies suggest that nitrates, including nitroglycerin, are effective antianginal agents, but their therapeutic value can be compromised by the development of tolerance during sustained therapy 2, 4.
- The optimal dosage and administration of nitrates vary depending on the individual patient and the specific condition being treated 3, 5, 6.