The stability of glyceryl trinitrate tablets during patient use

The stability of glyceryl trinitrate (GTN) tablets stored in ways commonly used by patients was investigated to enable pharmacists and physicians to give better advice about tablet storage. Analysis of 43 samples of tablets collected from hospital patients showed that the GTN content of these samples differed significantly from that of fresh tablets. Tablets kept in the manufacturer's bottle contained significantly more GTN than those transferred to other airtight vials (p less than 0.05) or pill boxes (p less than 0.005). The content of GTN was also significantly lower in tablets stored in pill boxes compared with other vials (p less than 0.01). Similar trends were found when tablets were stored in glass or plastic vials, pill boxes or were left exposed to air in the laboratory. These results emphasize that the best way to store GTN tablets is in the manufacturer's container. However, since many patients find that this bottle is awkward and inconvenient, a suitable alternative would be to carry a few tablets in a small airtight container (preferably glass). The unused tablets should be discarded every two weeks and nothing else should be added to the container. The use of pill boxes should be strongly discouraged.