What is the recommended dose and route for nitroglycerin in acute management?

• A. 0.8 mg SL every 10 minutes; no IV option
• B. 0.4 mg SL, repeat every 5 minutes; IV 5 mcg/min titrate to need
• C. 10 mg PO every 6 hours
• D. 2 mg IV bolus then 0.5 mcg/kg/min

Answer: (B)

In acute management, use a fast-acting nitroglycerin strategy that combines rapid relief with controlled continuation. Start with sublingual nitroglycerin 0.4 mg, repeat every 5 minutes for up to three doses to relieve chest pain. If pain or ischemia persists after those doses, switch to an intravenous infusion started at 5 mcg/min and titrate by ~5 mcg/min every few minutes to achieve relief and stable blood pressure. This approach leverages the quick onset of the sublingual form and the precise, adjustable control of IV therapy. Options with a higher SL dose, no IV route, oral dosing for acute care, or a bolus IV approach are not consistent with standard acute management.