Sublingual nitroglycerin tablets

STE and NSTE ACS, class I recommendation, for patients whose symptoms are not relieved after three serial sublingual nitroglycerin tablets or whose symptoms recur with adequate anti-ischemic therapy. 

Fung, H.-L., Yap, S. K., and Rhodes, . T. (1974), Development of a stable sublingual nitroglycerin tablet. I. Interaction of nitroglycerin with selected macro-molecules, /. Pharm. Sci., 63,1810. 

Nitrate therapy should be the first step in managing acute attacks of chronic stable angina if the episodes are infrequent (e.g., a few times per month). If angina occurs no more often than once every few days, then sublingual nitroglycerin tablets or spray or buccal products may be sufficient. 

Sublingual nitroglycerin tablets or nitroglycerin spray may be used for patients who develop shortness of breath with mild exercise, and they may be used much in the same way as in patients with ischemic symptoms. Nitroglycerin will decrease LV end-diastolic volume resulting in relief of breathlessness. 

Sublingual nitroglycerin, 0.3 to 0.4 mg, relieves pain in about 75% of patients within 3 minutes, with another 15% becoming pain-free in 5 to 15 minutes. Pain persisting beyond 20 to 30 minutes after use of two to three nitroglycerin tablets suggests ACS, and the patient should be instructed to... 

For prophylaxis when undertaking activities that predictably precipitate attacks, nitroglycerin 0.3 to 0.4 mg sublingually may be used about 5 minutes prior to the time of the activity. Nitroglycerin spray may be useful when inadequate saliva is produced to rapidly dissolve sublingual nitroglycerin or if a patient has difficulty opening the tablet container. The response usually lasts about 30 minutes. 

The oral route is, of course, the principal enteral route of drug administration. However, two other examples are worthy of note. First, the sublingual route (beneath the tongue) provides relatively good absorption because of its rich capillary bed it is routinely used for the administration of nitroglycerin tablets in the treatment of... 

Dryness of the mouth may also result in other problems. For example, the tricyclic antidepressant imipramine (e.g., Tofranil) can cause persistent dryness of the mouth. If nitroglycerin tablets are administered sublingually for the management of exertional angina, the relief of the symptoms may be delayed due to the slower dissolution of the sublingual tablets. 

S. A. Fusari, Nitroglycerin sublingual tablets 11 Preparation and stability of anew, stabilized, sublingual, molded nitroglycerin tablet, J. Pharm. Sci. 62, 2012-2021 (1973). 

Organic Nitrates Organic nitrates are available in a number of formulations that include rapid-acting nitroglycerin tablets or spray for sublingual administration, short-acting oral agents... 

Oral mucosal membranes provide a port for systemic therapy as weU. Nitroglycerin sublingual tablets (Nitrostat) abort acute mgina attacks methyl-testosterone [58-18-4] buccal tablets (Android 5) are indicated for testosterone [58-22-0] replacement therapy (39) md nicotine [54-11-5] gum (Nicorette) aids in smoking cessation. 

Promoting an Optimal Response to Therapy N URATES The nitrates may be administered by die sublingual (under die tongue), buccal (between the cheek and gum), oral, IV, or transdermal route Nitroglycerin may be administered by die sublingual, buccal, to peal, transdermal, oral, or IV route If die buccal form of nitroglycerin has been prescribed, die nurse instructs die patient to place die buccal tablet between die cheek and gum or between die upper lip and gum above die incisors and allow it to dissolve The nurse shows the patient how and where to place die tablet in die mouth. Absorption of sublingual and buccal forms is dependent on salivary secretion. Dry mouth decreases absorption. 

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