Standard Dose of Sublingual Nitroglycerin for Acute Angina

Dosing Protocol

• The standard dose of sublingual nitroglycerin is 0.3 to 0.6 mg per tablet, with the most commonly used dose being 0.4 mg, which can be repeated every 5 minutes for up to 3 doses for acute angina symptoms, as recommended by the American Heart Association 1
• The dose may be repeated approximately every 5 minutes until relief is obtained, with the American College of Cardiology suggesting a total of 3 tablets in a 15-minute period 1
• The onset of action is rapid, with effects occurring within 1 to 7 minutes, according to the American Heart Association 1

Available Formulations and Contraindications

• Sublingual tablets are available in 0.3 mg, 0.4 mg, and 0.6 mg strengths, with a maximum single dose of up to 1.5 mg, as stated by the American College of Cardiology 1
• Nitroglycerin is absolutely contraindicated within 24 hours of sildenafil use or 48 hours of tadalafil use due to risk of profound hypotension, myocardial infarction, and death, as warned by the American College of Cardiology 1, 2
• Avoid use if systolic blood pressure is less than 90 mm Hg or more than 30 mm Hg below baseline, as recommended by the American Heart Association 1

Intravenous Therapy

• If symptoms are not relieved after three 0.4-mg sublingual doses taken 5 minutes apart, intravenous nitroglycerin should be considered, according to the American College of Cardiology 1, 2
• Intravenous therapy is also indicated for patients with heart failure or hypertension complicating their acute coronary syndrome, as suggested by the American College of Cardiology 3