Nitroglycerin

Brands

nitroglycerin IV (Rx)

Brand and Other Names: glyceryl trinitrate IV, IV Nitroglycerin, NitroBid IV, NTG, Tridil
  • Classes: Nitrates, Angina

nitroglycerin transdermal (Rx)

Brand and Other Names: NitroDur, Minitran, Deponit, Transdermal Nitroglycerin, Nitrocine, glyceryl trinitrate transdermal
  • Classes: Nitrates, Angina; 
  • Vasodilators; 
  • Antianginal Agents

nitroglycerin topical (Rx)

Brand and Other Names: Nitrol, Nitro Bid, NitroBid Topical, glyceryl trinitrate topical, Topical Nitroglycerin
  • Classes: Nitrates, Angina

nitroglycerin PO (Rx)

Brand and Other Names: glyceryl trinitrate PO
  • Classes: Nitrates, Angina

nitroglycerin rectal (Rx)

Brand and Other Names:Rectiv
  • Classes: Gastrointestinal Agents, Other

nitroglycerin sublingual (Rx)

Brand and Other Names: Nitrostat, Nitrolingual Pumpspray, GoNitro, NitroQuick, glyceryl trinitrate sublingual, Sublingual Nitroglycerin
  • Classes: Nitrates, Angina

nitroglycerin translingual (Rx)

Brand and Other Names: Nitrolingual, glyceryl trinitrate translingual spray, NitroMist
  • Classes: Nitrates, Angina; 
  • Antianginal Agents
Organic nitrate vasodilator; available in many dosage forms.
Used for angina, HTN, CHF, AMI, hypertensive emergency, hypotension induction during surgery, and used in a rectal ointment for pain associated with chronic anal fissures.
Chronic use may be associated with nitrate tolerance.
Indicated for the treatment of angina pectoris due to coronary artery disease.

Indicated for treatment of moderate-to-severe pain associated with chronic anal fissures; consider use if conservative treatment for acute symptoms of anal fissure fails

 
For the treatment of moderate to severe pain associated with chronic anal fissures.
For controlled hypotension induction during anesthesia; for the treatment of acute congestive heart failure or pulmonary edema, acute angina pectoris or unstable angina, acute myocardial infarction, or acute pulmonary hypertension; or for treatment of severe hypertension, postoperative hypertension, perioperative hypertension (e.g., during cardiac surgery), or hypertensive emergency.
For use as a uterine relaxant to aid in extraction of a retained placenta.
For the treatment of extravasation of vasoactive medications.

Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life

Riociguat; coadministration may cause hypotension

Narrow angle glaucoma (controversial: may not be clinically significant)

Hypersensitivity

Symptomatic hypotension, uncorrected hypovolemia, increased intracranial pressure (head trauma, cerebral hemorrhage), severe anemia, constrictive pericarditis, pericardial tamponade, restrictive cardiomyopathy

Common

Headache

Hypotension

Tachycardia

Dyspnea

Dizziness

Lightheadedness

Blurred vision

Flushing

N/V

Nervousness

Xerostomia

Serious

Methemoglobinemia (rare)

Syncope

Prolonged bleeding time

Exfoliative dermatitis

Unstable angina

Rebound hypertension

Thrombocytopenia

Use caution in alcohol use, hyperthyroidism, hypertrophic cardiomyopathy, postural hypotension, severe renal impairment, hepatic impairment

Gradually decrease dose to avoid withdrawal reaction

May need 10-12 hr/day nitrate-free interval to avoid tolerance development

Doses ~ 200 mcg/min

Some products contain alcohol and propylene glycol

Remove topical forms when starting IV infusion

Use glass bottles and non-PVC (polyvinyl chloride) tubing to avoid adsorption of drug to delivery devices; use of PVC tubing in infusion sets may lead to loss of active ingredient due to adsorption of nitroglycerin to PVC tubing; dosage is affected; adsorption by PVC tubing is increased when tubing is long, flow rates are low, and nitroglycerin concentration of solution is high; delivered fraction of solution’s original nitroglycerin content has been 20-60% in published studies; fraction varies with time during single infusion, and no simple correction factor can be used; if intravenous nitroglycerin is administered through non-adsorptive tubing, doses based upon published reports will generally be too high; some in-line intravenous filters also adsorb nitroglycerin and should be avoided

Solutions containing dextrose without electrolytes should not be administered through the same administration set as blood, as this may result in pseudoagglutination or hemolysis

Pregnancy Category: C

Lactation: Developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for nitroglycerin and any potential adverse effects on breastfed child from nitroglycerin or from underlying maternal condition

Adults

The maximum dosage is dependent on route of administration and indication for therapy.

Geriatric

The maximum dosage is dependent on route of administration and indication for therapy.

Adolescents

The maximum dosage is dependent on route of administration and indication for therapy; safety and efficacy of the 0.4% rectal ointment have not been established.

Children

The usual maximum rate is 5 mcg/kg/min; however, IV rates up to 20 mcg/kg/min have been used. Safety and efficacy of the 0.4% rectal ointment have not been established.

Infants

Safety and efficacy have not been established.

Neonates

Safety and efficacy have not been established.

Nesiritide

infusion solution

  • 25mg/250mL
  • 50mg/250mL
  • 100mg/250mL

injectable solution

  • 5mg/mL

patch

  • 0.1mg/hr
  • 0.2mg/hr
  • 0.3mg/hr
  • 0.4mg/hr
  • 0.6mg/hr
  • 0.8mg/hr

ointment

  • 2%

capsule, extended release

  • 2.5mg
  • 6.5mg
  • 9mg

ointment, intra-anal

  • 0.4% (4mg nitroglycerin/1g of ointment)

tablet, SL

  • 0.3mg
  • 0.4mg
  • 0.6mg

powder, SL (GoNitro)

  • 0.4mg

spray

  • 0.4mg/spray

 

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