Last updated: August 2021
- Vasodilator, antianginal
- Prophylaxis and treatment of acute angina
- Treatment of left-sided or global chronic heart failure in patients with intolerance to angiotensin-converting enzyme (ACE) inhibitors
- Adjunctive therapy in acute heart failure (acute pulmonary oedema)
Forms and strengths
- 5 mg sublingual tablet
Short-term prophylaxis of acute angina
- Adult: 5 to 10 mg sublingually taken 10 minutes before a precipitating event (physical exertion, stress, etc.)
Long-term prophylaxis of acute angina and treatment of left-sided or global chronic heart failure
- Adult: 5 to 40 mg orally 2 to 3 times daily
Gradually increase the dose until effective. Do not stop treatment abruptly.
Treatment of acute angina
- Adult: 5 to 10 mg sublingually, to be repeated after 10 minutes if necessary
Adjunctive therapy in acute heart failure (acute pulmonary oedema)
- Adult: 5 mg sublingually, to be repeated after 10 minutes if necessary. The objective is to lower the systolic pressure to 120-150 mmHg and the diastolic pressure to under 110 mmHg.
- According to clinical response
Contra-indications, adverse effects, precautions
- Do not administer to patients with obstructive cardiomyopathy, hypotension, shock, severe anaemia, intracranial hypertension or neurologic injury.
- May cause:
- orthostatic hypotension (especially in older patients), headache, nausea, flushing of the face, haemolytic anaemia in patients with G6PD deficiency;
- severe hypotension with risk of circulatory collapse in the event of overdose.
- Avoid combination or use the lowest effective dose in patients taking another nitrate derivative, a vasodilator, a diuretic or an antihypertensive drug (enhances hypotensive effects), and in older patients.
- Do not combine with sildenafil or other drugs used for erectile dysfunction (risk of severe hypotension, syncope and acute coronary syndrome).
- Pregnancy: not recommended (safety is not established)
- Breast-feeding: not recommended (safety is not established)
- By sublingual route, antianginal effect appears within less than 10 minutes and persists for 1 to 2 hours.
- Tolerance to nitrates develops with prolonged use and can be overcome by short periods of nitrate withdrawal, and not by dose escalation.
- Sustained-release formulations are used for the long-term management of acute angina and the treatment of heart failure. The time interval between each administration depends on the preparations.