Nitroglycerin lingual spray: clinical efficacy and dose-response relation.

Twenty patients with chronic, stable, exercise-induced angina pectoris were studied after receiving lingual sprays that delivered 0.2, 0.4 and 0.8 mg of nitroglycerin (GTN). The hemodynamic effects and changes in exercise time to the onset of angina and to the development of moderate angina were compared with those of placebo spray and 0.4 mg of sublingual GTN. A dose-response relation was apparent with the 3 doses of active spray for heart rate at rest but not for standing systolic blood pressure. Sublingual GTN produced effects similar to those with 0.4 and 0.8 mg of GTN spray, but exceeded the response to 0.2 mg of GTN spray. Treadmill walking time to the onset of angina and to the development of moderate angina was prolonged with each dose of GTN spray and showed a dose-response relation with significantly greater effects with increasing doses of GTN spray. This study indicates that GTN lingual spray is effective in the prophylaxis of angina and should be effective in the therapy of exercise-induced or spontaneous episodes of angina pectoris. The dose of 0.4 or 0.8 mg would appear to be most effective and similar to 0.4 mg of sublingual GTN.