Nitroglycerin

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 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

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 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.