Use of sublingual nifedipine in the treatment of coronary artery spasm

✍ Scribed by Davis, W. Ross

• Publisher: John Wiley and Sons
• Year: 1988
• Tongue: English
• Weight: 94 KB
• Volume: 15
• Category: Article
• ISSN: 0098-6569
• DOI: 10.1002/ccd.1810150319

✦ Synopsis

MD, in Volume 14, Number 4 of the journal Catheterization and Cardiovascular Diagnosis [l]. Ironically, two days prior to receiving this issue, I had just talked with the Professional Services Department of Pfizer Laboratories in New York about a more effective method of delivering nifedipine sublingually. I had suggested a 10-mg ampule or even a multidose dropper bottle to speed the delivery of this drug in emergent situations such as during cardiac catheterization procedures. Their representative stated that it would require extensive FDA review to gain approval for a different method of packaging.

The next morning, during a catheterization procedure, nifedipine was ordered given sublingually. I had set up a few doses as described in the article and did indeed find that one could deliver the medication with less trouble than before. However, after examining the capsule more closely, I decided a more careful investigation was needed to determine just how much of the medication was being delivered.

Nifedipine capsules were found to contain about .27 ml of liquid for a 10-mg dose. After expressing the liquid from successive capsules with the "syringe" method, I determined that the total amount delivered ranged from .08 ml to .10 ml for a delivered dosage of only 2.9 mg to 3.7 mg! I strongly urge that a warning be placed in the next issue to dissuade the use of this method of sublingual delivery. The dosage is unpredictable and invariably subtherapeutic compared to the "messy fingers" method.

It is my opinion that the problems associated with dispensing nifedipine sublingually need to be addressed immediately by both the manufacturer and the FDA. The efficacy of this drug need not be compromised by difficulties in administration.