IV nitroglycerine alternatives

Background

• Suggestions for substitution during the IV shortage

Nitroglycerine Bioavailability

• Oral : <1%
• Sublingual : 38% (15-40%)
• Topical : 72%

Half-life: 0.05 h

Suggested Substitutions

• Sublingual nitroglycerin, 1-2 tabs or sprays every 5 minutes as needed
  • Once controlled
    • Nitroprusside OR Isordil PO (nitro paste or longer acting NTG)
  • If not well controlled
    • IV enalapril 0.625-1.25mg IV bolus
    • IV hydralazine 5-10mg IV bolus
    • IV nitroprusside

See Also

• Hypertensive emergency
• Congestive heart failure

References

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