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August 1992

Sublingual Captopril and Nifedipine in Immediate Treatment of Hypertensive Emergencies-Reply

Arch Intern Med. 1992;152(8):1725-1726. doi:10.1001/archinte.1992.00400200147033

In Reply.—  We thank Hasdai for his comments on our article1 in the ArCHIVES. He raised some criticisms about the sublingual administration of the drugs used in our study on the basis of both pharmacokinetic and pharmacodynamic observations on the chosen drugs and about the guidelines of treatment of hypertensive emergencies.As far as sublingual nifedipine dosage is concerned, we agree that sublingual or buccal absorption of nifedipine is uncertain and that it is small. But, it is really difficult to squeeze a perforated capsule of nifedipine under the tongue without swallowing saliva. We think that the dissolution of the nifedipine capsule in the mouth and swallowing of the content is the critical factor in providing a more rapid rise in plasma nifedipine concentration compared with standard oral administration. Thus, we find it to be more correct to say "drug dissolved sublingually" than "absorbed sublingually," in accordance with other

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