Nitroglycerin

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General

  • Type: vasodilator; stimulates cGMP production causing vascular smooth muscle relaxation
  • Dosage Forms: SL, IV
  • Common Trade Names: Nitrolingual, NitroMist, Nitrostat

Adult Dosing

Angina, acute

  • 0.3 - 0.6mg SL q5min, max: 3 doses within 15 min
  • IV form: 5 mcg/min IV, increase 5-20 mcg/min q3-5min.

Hypertension

  • 5-200 mcg/min IV, start 5 mcg/min IV and increase 5 mcg/min q3-5min

Pediatric Dosing

Hypertension/CHF

  • 1-5 mcg/kg/min IV, start 0.25-0.5 mcg/kg/min, max: 20 mcg/kg/min

Special Populations

  • Pregnancy Rating: C
  • Lactation: safety unknown
  • Renal Dosing
    • Adult: no adjustment
    • Pediatric: no adjustment
  • Hepatic Dosing
    • Adult: not defined
    • Pediatric: not defined

Contraindications

  • Allergy to class/drug
  • Pericardial tamponade
  • Severe anemia
  • Sildenafil use within the past 24 hours or tadalafil within the past 48 hours[1][2]
  • Methemoglobinemia
  • Caution in hypotension

Adverse Reactions

Serious

  • hypotension
  • bradycardia
  • methemoglobinemia

Common

  • headache
  • dizziness
  • flushing
  • hypotension
  • reflex tachycardia
  • edema

Pharmacology

  • Half-life: 1-3 min
  • Metabolism: liver, erythrocytes, vascular walls
  • Excretion: urine
  • Mechanism of Action: stimulates cGMP production resulting in vascular smooth muscle relaxation

See Also

External Links

References

  1. Kloner RA, Hutter AM, Emmick JT, Mitchell MI, Denne J, Jackson G. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003 Nov 19;42(10):1855-60.
  2. Cheitlin MD, Hutter AM Jr, Brindis RG, et al. ACC/AHA/Nizagara-online.net expert consensus document: use of sildenafil (Viagra) in patients with cardiovascular disease: American College of Cardiology/American Heart Association. J Am Coll Cardiol 1999;33:273-82.