Home › Instruction sheets › Chest pain from angina: using the tablet under the tongue

For people with known angina who have been prescribed a nitrate tablet (isosorbide dinitrate 5 mg or glyceryl trinitrate 0.5 mg) or spray to use when chest pain comes.

Drawing: The heart, the tablets, the spray, a chair to sit on, and a phone to call 108. — The heart, the tablets, the spray, a chair to sit on, and a phone to call 108.

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Patient's name Date Your tablet or spray Family member to call

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When the chest pain comes

Stop what you are doing and sit down.
Put one tablet under your tongue and let it dissolve. Do not chew or swallow it. With a spray: one or two sprays under the tongue, then close your mouth.
Wait 5 minutes.
If the pain has not gone, or is getting worse: call 108 now. Do not wait longer.
While waiting for help, you may take a second dose, and a third after another 5 minutes. Not more than 3 doses in 15 minutes.

If you have aspirin within reach and are not allergic to it, chew 300 to 350 mg while you wait: one soluble aspirin tablet of 325 or 350 mg, or two tablets of 150 mg. Do not go looking for it, and do not delay the call. If you take a blood thinner, take the extra aspirin only if the ambulance team or a doctor tells you to.

It may be a heart attack if there is

Pressure, squeezing or pain in the chest lasting more than a few minutes
Pain spreading to the arm, neck, jaw, back or stomach
Breathlessness, a cold sweat, nausea or light-headedness
In women, older people and people with diabetes, sometimes only breathlessness, vomiting, unusual tiredness or back pain

Call 108 or go to the nearest hospital with a cardiac emergency service. Caspian has no cath lab, intensive care unit or emergency department. Do not drive yourself.

Never use it if

You have taken sildenafil or vardenafil in the last 24 hours, or tadalafil in the last 48 hours. Together they cause a dangerous fall in blood pressure. Do not take the nitrate. Call 108 and tell the emergency doctor exactly what you took.

What to expect

Headache, flushing and dizziness are common and pass. This is why you must sit down first.
If you feel faint, lie down and raise your legs.
Paracetamol can be taken for the headache.

Using it wisely

Carry it with you always. Keep some by the bed.
You can take one dose 5 to 10 minutes before an activity that usually brings on the pain.
Glyceryl trinitrate tablets in a bottle lose strength quickly: keep them in the original glass bottle, tightly closed, and throw away what is left 8 weeks after opening. Tablets in a strip stay in the strip until needed. Check the expiry date.
Keep it away from heat and sunlight. Not in a shirt pocket against the body all day.

See your doctor the same day if

The pain is coming more often, with less effort, or at rest
You are needing the tablet more than before
The pain wakes you at night

A change in the pattern is a warning, even if each attack settles.

Questions about this sheet? Call Caspian Healthcare reception on +91 89193 41154. A doctor is on duty at all hours for problems that are not critical. Caspian has no emergency department: in an emergency call 108.

Where this comes from

Prepared by Caspian Healthcare from the sources above. Last reviewed October 2026. General information: your own doctor's written instructions come first.