The Hospice Clinician Blog

Sublingual nitroglycerin (Nitrostat) is indicated for the relief of an acute angina attack. One sublingual tablet should be used at the first sign of an acute attack. Up to two additional doses can be taken at 5 minute intervals if relief is not seen.

In the past, patients have been counseled to contact EMS if angina is still not relieved after 3 doses. However, the American College of Cardiology and the American Heart Association revised these recommendations in 2004, recognizing that delay in seeking medical attention (as may occur during this 15 minute span) may adversely affect patient survival. The updated recommendations state that patients should contact EMS if there is no relief after just one dose of sublingual nitroglycerin. Patients should continue to use the second and third doses, if needed, while waiting for EMS to arrive. Patients are also encouraged to wait for an ambulance rather than having family or friends provide transportation to the hospital, so that they may be treated en route if necessary. 

Further counseling points regarding sublingual nitroglycerin include:

• Patients should take nitroglycerin while sitting, in case they become dizzy or lightheaded.
• The tablets do not need to be replaced every 6 months, as was previously recommended. If tablets are properly stored and handled, they should be stable until the expiration date indicated by the manufacturer.

The same recommendations also apply to nitroglycerin lingual spray (e.g. Nitrolingual, NitroMist). An important note about the spray is that it must be "primed" with one spray before being used for the first time, and must be reprimed if not used for 6 weeks.

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