Treatment of episodes of angina
Knuuti, 2020National Institute for Health and Care Excellence (NICE), 2011 [Last updated 2016]
Give all patients with angina a written chest pain action plan1.
Advise patients to stop activities as soon as angina pain is felt. To shorten an episode of angina, use:
1glyceryl trinitrate spray 400 to 800 micrograms sublingually, repeat every 5 minutes if pain persists, up to a total of 3 sprays (1200 micrograms) if tolerated glyceryl trinitrate glyceryl trinitrate glyceryl trinitrate
OR
1glyceryl trinitrate tablet 300 to 600 micrograms sublingually, repeat every 5 minutes if pain persists, up to a total of 3 doses (1800 micrograms) if tolerated. glyceryl trinitrate glyceryl trinitrate glyceryl trinitrate
Patients with an initial episode of angina should use the lower dose of glyceryl trinitrate tablet (300 micrograms); a patient with established angina should use the higher dose (600 micrograms).
Advise patients that if pain persists for more than 10 minutes despite taking 2 doses of glyceryl trinitrate, they should take a third dose and call an ambulance for transfer to hospital.
Instruct all patients on the use of glyceryl trinitrate and warn of possible adverse effects. Before taking glyceryl trinitrate, they should sit down to avoid orthostatic hypotension. Consider giving a single trial dose of glyceryl trinitrate under supervision when the patient is asymptomatic so that they will recognise its effect.