Buccal versus sublingual nitroglycerin administration in the treatment of angina pectoris: a multicentre study

Buccal (Suscard) was compared with sublingual nitroglycerin (Nitromex) in 126 patients with stable angina pectoris. Following a dose adjustment period they were randomized to cross-over treatment, two weeks on sublingual and buccal nitroglycerin, respectively. The dosage of buccal nitroglycerin was 2.5 mg in 49% and 5.0 mg in 51%. The total number of treated acute anginal attacks was 31% less during the buccal compared to the sublingual nitroglycerin period (P less than 0.001) despite a reported physical activity level which was significantly higher during the buccal nitroglycerin period. The use of sublingual nitroglycerin and buccal nitroglycerin was considered equally simple by 67%, sublingual nitroglycerin easier by 19% and buccal nitroglycerin easier by 14% of the patients. Sublingual nitroglycerin was used prophylactically on 806 occasions and buccal nitroglycerin on 929 occasions (P less than 0.05) with success in 66% of the sublingual nitroglycerin-attempts and 74% of the buccal nitroglycerin-attempts (P less than 0.05). Considering only prophylactic use, buccal nitroglycerin was preferred by 81% and sublingual nitroglycerin by 4% (P less than 0.05). When given the opportunity only to select one of the two nitroglycerin formulations, 65% (P less than 0.05) preferred buccal nitroglycerin and 19% sublingual nitroglycerin. In conclusion, buccal nitroglycerin seems to be more efficacious than sublingual nitroglycerin. The explanation is probably that the two formulations are comparable in the treatment of acute anginal attacks, while buccal nitroglycerin has a more pronounced prophylactic effect due to its longer duration of action.