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 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
• 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

External Links

• EMCrit: Sympathetic Crashing Acute Pulmonary Edema (SCAPE)