Onset time of action and duration up to 3 hours of nitroglycerin in buccal, sublingual and transdermal form

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Abstract
Nitroglycerin in sublingual, buccal and transdermal administration forms were compared in 10 patients with stable exercise-induced angina pectoris with respect to onset time of action and efficacy one and three hours after administration, using bicycle exercise to provoke chest pain. Anti-anginal and anti-ischaemic effects (as judged by influence on electrocardiographic ST depression) began within 2 minutes of application of the buccal and sublingual forms, whereas the transdermal patch did not show such effects within nine minutes of application. One and three hours after-application, the sublingual form had no effect whereas both the transdermal and buccal forms significantly increased exercise capacity and improved electrocardiographic ST segment changes. The 2-5 mg buccal tablet was more effective than the 10 mg transdermal patch. An additional observation was that a light snack at 2 hours significantly decreased exercise capacity at 3 hours whether or not active treatment had been instituted.