Buccal versus Sublingual Glyceryl Trinitrate Administration in the Treatment of Angina Pectoris

Summary

126 patients with chronic exercise-induced angina, who were accustomed to the use of sublingual glyceryl trinitrate, were entered into a multicentre 2-week crossover comparison of sublingual (Nitromex) and buccal (Suscard®) formulations of glyceryl trinitrate. Before randomisation the patients underwent a training period when doses of the buccal formulation were individualised. There were 31% fewer attacks with the buccal formulation, and more patients reported higher physical activity on the buccal compared with the sublingual formulation (30% vs 16%). The buccal formulation was also more effective when glyceryl trinitrate was used prophylactically to prevent expected attacks, being effective in 74% of attempts compared with 66% for the sublingual formulation (p<0.05). More patients preferred the buccal route of administration for prophylactic use (81% vs 4%, p<0.05). Similarly, when asked to select which they would use in future, 65% of patients preferred the buccal formulation (p<0.05), 19% preferred sublingual glyceryl trinitrate, and 16% did not express any preference.