From the Guidelines
0.4 milligram sublingual nitroglycerin is indicated for immediate relief of acute angina pectoris or myocardial infarction symptoms, and should be administered every 5 minutes (up to three doses) in patients with no contraindicions, such as hypotension, bradycardia, or phosphodiester──desaccharide inhibitor use for erectile dysfunction within the past 24 hours [48 hours for tadalafil (Cialis)]. According to the acc/aha guideline update for the management of st-segment elevation myocardial infarction 1, sublingual nitroglycerin can be given to patients with suspected myocardial infarction, alongside other medications such as morphine sulfate and aspirin. Key considerations for administration include:
- Patient should have no contraindications for nitrate use
- Dose should not exceed three doses, given every 5 minutes
- Patient should be monitored for potential side effects, such as hypotension and headache
- Nitroglycerin should be used in conjunction with other treatments, such as aspirin and morphine, as part of a comprehensive treatment plan for myocardial infarction. The use of sublingual nitroglycerin in this context is supported by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines 1.
From the FDA Drug Label
Nitroglycerin sublingual tablets are indicated for the acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease.
- Indication: 0.4 milligram sublingual nitroglycerin is indicated for the acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease.
- The specific dose of 0.4 milligram is not mentioned in the indication, but it is implied to be used for the same purpose as the drug itself 2
From the Research
Indications for 0.4 milligram sublingual nitroglycerin (glyceryl trinitrate)
- 0.4 milligram sublingual nitroglycerin is indicated for the treatment of angina pectoris, specifically for patients who experience predictably favorable response of chest pain to sublingual nitroglycerin 3
- It is also indicated for patients with angina episodes suggestive of coronary vaso-constriction or spasm, left ventricular systolic dysfunction, and symptoms of congestive heart failure (systolic or diastolic dysfunction) 3
- Sublingual nitroglycerin is the most effective antianginal agent for exertional angina pectoris, primarily due to its peripheral effects of venodilation and arterial dilation, and thereby reduction in myocardial oxygen demand 4
- It can be used for symptom relief and to increase angina-free walking time in patients with stable angina pectoris 5
- However, its prophylactic use is limited by its short duration of action, and development of tolerance to the circulatory and antianginal effects during chronic therapy remains a concern 4
Patient Characteristics for Nitrate Therapy
- Ideal patient characteristics for nitrate therapy include:
- Predictably favorable response of chest pain to sublingual nitroglycerin
- Angina episodes suggestive of coronary vaso-constriction or spasm
- Left ventricular systolic dysfunction
- Symptoms of congestive heart failure (systolic or diastolic dysfunction) 3
Combination Therapy
- Combined use of nitrates and beta-blockers is a rational approach, because the pharmacological actions of the 2 drugs produce complementary haemodynamic effects 6
- Additive effects of nitrates and calcium antagonists have been found in angina produced by coronary artery spasm, but the effects of the combination in stable angina pectoris are not well documented 6