Nitrates
PREGNANCY CATEGORY C
Therapeutic Actions
Nitrates are antianginals. They relax vascular smooth muscle with a resultant decrease in venous return and decrease in arterial blood pressure, which reduces left ventricular workload and decreases myocardial oxygen consumption, relieving the pain of angina.
Indications
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Treatment of acute angina (sublingual, translingual, inhalant preparations)
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Prophylaxis of angina (oral sustained release, sublingual, topical, transdermal, translingual, transmucosal preparations)
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Treatment of angina unresponsive to recommended doses of organic nitrates or betablockers (IV preparations)
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Management of perioperative hypertension, heart failure associated with acute MI (IV preparations)
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Produce controlled hypotension during surgery (IV preparations)
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Unlabeled uses: Reduction of cardiac workload in acute MI and in heart failure (sublingual, topical); diffuse esophageal spasm without reflux
Contraindications and Cautions
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Contraindicated with allergy to nitrates, angle-closure glaucoma, severe anemia, early MI, head trauma, cerebral hemorrhage, cardiomyopathy, concommitant use with phosphodiesterase type 5 (PDE5) inhibitors, pregnancy, or lactation.
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Use cautiously with hepatic or renal disease, hypotension or hypovolemia, increased intracranial pressure, constrictive pericarditis, pericardial tamponade, low ventricular filling pressure or low pulmonary capillary wedge pressure (PCWP).
Adverse Effects
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CNS: Headache, apprehension, restlessness, weakness, vertigo, dizziness, faintness
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CV: Tachycardia, retrosternal discomfort, palpitations, hypotension, syncope, collapse, orthostatic hypotension, angina
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Dermatologic: Rash, exfoliative dermatitis, cutaneous vasodilation with flushing, pallor, perspiration, cold sweat, contact dermatitis (transdermal preparations), topical allergic reactions (topical nitroglycerin ointment)
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GI: Nausea, vomiting, incontinence of urine and feces, abdominal pain
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Local: Local burning sensation at the point of dissolution (sublingual)
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Other: Ethanol intoxication with high dose IV use (alcohol in diluent)
Interactions
Drug-drug • Increased risk of hypertension and decreased antianginal effect with ergot alkaloids • Decreased pharmacologic effects of heparin • Risk of orthostatic hypotension with calcium channel blockers • Profound hypotension with PDE5 inhibitors
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