Nitroglycerin(nye troe gli’ ser in)
Intravenous: generic
Ointment: Rectiv
Spray: Nitrolingual Pumpspray
Sublingual: Gen-Nitroglycerin (CAN), Nitrostat
Sustained-release: Nitro-TimeDNC
Topical: Nitro-Bid
Transdermal: Minitran, Nitrek, Nitro-Dur
Translingual: Nitrolingual
PREGNANCY CATEGORY C
Drug Classes
Antianginal
Nitrate
Therapeutic Actions
Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.
Indications
Sublingual, translingual preparations: Acute angina
Oral SR, sublingual, topical, transdermal, translingual preparations: Prophylaxis of angina
IV: Angina unresponsive to recommended doses of organic nitrates or beta blockers
IV: Perioperative hypertension
IV: HF associated with acute MI
IV: To produce controlled hypotension during surgery
Topical ointment: Treatment of moderate to severe pain associated with anal fissure (Rectiv)
Unlabeled uses: Reduction of cardiac workload in acute MI and in HF (sublingual, topical) adjunctive treatment of Raynaud disease (topical)
Contraindications and Cautions
Contraindicated with allergy to nitrates, severe anemia, early MI, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, pregnancy, lactation.
Use cautiously with hepatic or renal disease, hypotension or hypovolemia, increased intracranial pressure, constrictive pericarditis, pericardial tamponade, low ventricular filling pressure or low PCWP.
Available Forms
Injection for solution (requires dilution)—5 mg/mL; injection (premixed)—100, 200, 400 mcg/mL; sublingual tablets—0.3, 0.4, 0.6 mg; ER buccal tablets—2.3 mg; translingual spray—0.4 mg/spray; oral SR capsules—2.5, 6.5, 9 mg; transdermal—0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hr; topical ointment—0.4%, 2%
Dosages
Adults
IV
Initial dose, 5 mcg/min IV delivered through an infusion pump. Increase by 5-mcg/min increments every 3–5 min as needed. If no response at 20 mcg/min, increase increments to 10–20 mcg/min. Once a partial BP response is obtained, reduce dose and lengthen dosage intervals; continually monitor response and titrate carefully.
Sublingual
Acute attack: Dissolve one tablet under tongue or in buccal pouch at first sign of anginal attack; repeat every 5 min until relief is obtained. Do not take more than three tablets/15 min. If pain continues or increases, patient should call physician or go to hospital.
Prophylaxis: Use 5–10 min before activities that might precipitate an attack.
Buccal
Place tablet between the lip and gum and allow it to dissolve over 3–5 min. Do not chew or swallow the tablet. Initial dose is 1 mg every 5 hr while awake. Maintenance dose is 2 mg tid.
SR (oral)DNC
Initial dose, 2.5–9 mg every 12 hr. Increase to every 8 hr as needed and tolerated. Doses as high as 26 mg given qid have been used.
Topical
Initial dose, one-half inch every 8 hr. Increase by one-half inch to achieve desired results. Usual dose is 1–2 inches every 8 hr; up to 4–5 inches every 4 hr have been used. 1 inch = 15 mg nitroglycerin.
Transdermal
Apply one patch each day. Adjust to higher doses by using patches that deliver more drug
or by applying more than one patch. Apply patch to arm; remove at bedtime.
or by applying more than one patch. Apply patch to arm; remove at bedtime.
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