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Nitroglycerin

Classification

Antianginal

Indications

EMR: Relief from chest pain suggestive of acute coronary syndrome

ACP: Reduction of preload in acute cardiogenic pulmonary edema

Contraindications

Known allergy or hypersensitivity to nitroglycerin
Use of Viagra (sildenafil) or Levitra (vardenafil) within the previous 24 hours
Use of Cialis (tadalafil) within the previous 48 hours
Severe anemia
Restrictive pericarditis or pericardial tamponade
Documented right sided acute myocardial infarction
Hypotension or uncorrected hypovolemia
Systolic blood pressure < 110 mmHg - for EMRs and PCPs
Heart Rate <50 or >150 - for EMRs and PCPs

Adult dosages

EMR & PCP: Relief from chest pain suggestive of acute coronary syndrome

CliniCall consultation required prior to administration if the patient has no prior prescription for nitroglycerin or if more than 3 doses are required.

0.4 mg SL every 3-5 minutes
- Verify systolic blood pressure prior to administering each dose; systolic blood pressure must be ≥ 110 mmHg and heart rate must be between 50 and 150 beats/minute

ACP: Reduction of preload in acute cardiogenic pulmonary edema

0.4 mg SL every 3-5 minutes

CCP: All indications

10-200 mcg/min IV infusion

Pediatric Considerations And Dosing

Not authorized for use in pediatrics

Mechanism Of Action

Relaxes smooth muscle in vasculature. Nitroglycerin works primarily as a venodilator, but can also produce coronary and systemic arterial vasodilation, decreasing preload and lowering myocardial oxygen demand.

Pharmacokinetics

Onset: 30 seconds - 2 minutes (SL); 30 seconds - 1 minute (IV)
Peak: 5-10 minutes (SL); 3-5 minutes (IV)
Duration: 15-30 minutes (SL/IV)

Adverse Effects

Hypotension
Headache
Nausea

Warning And Precautions

Do not administer to patients with a blood pressure < 110 mmHg or who are exhibiting signs of significant hypoperfusion.
Use with caution in patients with hepatic or renal insufficiency.
Exercise caution (and rule out right-sided involvement) in patients with documented inferior ischemia on 12-lead ECG.
Exercise caution in patients with clinically significant aortic stenosis.

Drug Interactions

Antihypertensive agents may act synergistically with nitroglycerin.