IV nitroglycerine alternatives

Background

• Suggestions for substitution during the IV shortage

Nitroglycerine Bioavailability

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

Half-life<http://sepia.unil.ch/pharmacology/index.php?id=60> (t1/2) 0.05 h

Suggested Substitutions

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

Source

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