New nitrate delivery systems: buccal nitroglycerin.

BN, a new nitrate formulation, has recently been made available. The main advantages of this medication is the combination of prompt onset of action, comparable to that of sublingual NTG, and sustained activity that persists for many hours. The tablet remains pharmacologically effective as long as it remains in the buccal pouch. A variety of studies indicate that BN is well tolerated by patients, acts promptly to provide protection against anginal pain, and has sustained efficacy that persists for 2 to 6 hours. Clinical investigations using serial treadmill testing in patients with angina demonstrate clinical effectiveness and bioactivity of BN beginning within minutes and lasting over 4 hours. The potential advantages of this preparation are discussed, and the formulation is compared to other available longacting nitrates. BN is an effective new addition to the nitrate armamentarium.