Nitroglycerin

nitroglycerin, intravenous

(nye troe gli' ser in)
Nitro-Bid IV, Tridil

nitroglycerin, sublingual

Nitrostat

nitroglycerin, sustained release

Nitroglyn, Nitrong, Nitro-Time

nitroglycerin, topical

Nitrobid, Nitrol, Nitrong, Nitrostat

nitroglycerin, transdermal

Deponit, Minitran, Nitro-Dur, Nitrodisc, Transderm-Nitro, Nitro-Derm

nitroglycerin, translingual

Nitrolingual

nitroglycerin, transmucosal

Nitrogard

Pregnancy Category C

Drug classes


Therapeutic actions


Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

Indications

Contraindications/cautions


Dosage


Available Forms: Injection--0.5, 5 mg/mL; injection solution--25, 50, 100, 200 mg; sublingual tablets--0.15, 0.3, 0.4, 0.6 mg; translingual spray--0.4 mg/spray; transmucosal tablets--1, 2, 3 mg; transmucosal SR tablets--2.6, 6.5, 9 mg; transmucosal SR capsules--2.5, 6.5, 9, 13 mg; transdermal--.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/h; topical ointment--2%

Adult

Intravenous:

Initial: 5 µg/min delivered through an infusion pump. Increase by 5-µg increments every 3---5 min as needed. If no response at 20 µg, increase increments to 10---20 µg. Once a partial BP response is obtained, reduce dose and lengthen dosage intervals; continually monitor response and titrate carefully.

Sublingual

Acute attack:
Dissolve 1 tablet under tongue or in buccal pouch at first sign of anginal attack; repeat every 5 min until relief is obtained. Do not take more than 3 tablets/15 min. If pain continues or increases, patient should call physician or go to hospital.
Prophylaxis:
Use 5---10 min before activities that might precipitate an attack.

Sustained release (oral):

Initial:2.5---2.6 mg tid or qid. Titrate upward by 2.5- or 2.6-mg increments until side effects limit the dose. Doses as high as 26 mg given 4 × daily have been used.

Topical:

Initial dose: 1/2 in q8h. Increase by 1/2 inch to achieve desired results. Usual dose is 1---2 inches q8h; up to 4---5 inches q4h have been used. 1 inch = 15 mg nitroglycerin.

Transdermal:

Apply one pad each day. Titrate to higher doses by using pads that deliver more drug or by applying more than one pad.

Translingual:

Spray preparation delivers 0.4 mg/metered dose. At onset of attack, spray 1---2 metered doses into oral mucosa; no more than 3 doses/15 min should be used. If pain persists, seek medical attention. May be used prophylactically 5---10 min prior to activity that might precipitate an attack.

Transmucosal:

1 mg q3---5h during waking hours. Place tablet between lip and gum above incisors, or between cheek and gum.

Pediatric:

Safety and efficacy not established.

Pharmacokinetics

RouteOnsetDuration
IV1---2 min3---5 min
Sublingual1---3 min30---60 min
TL spray2 min30---60 min
Trans/tablet1---2 min3---5 min
Oral, SR20---45 min3---8 h
Topical ointment30---60 min2---12 h
Transdermal30---60 min24 h

Metabolism: Hepatic, T1/2: 47---100 h

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

IV facts


Adverse effects


Clinically important interactions


Nursing Considerations


Assessment


History: Allergy to nitrates, severe anemia, early MI, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, hepatic or renal disease, hypotension or hypovolemia, increased intracranial pressure, constrictive pericarditis, pericardial tamponade, low ventricular filling pressure or low PCWP, pregnancy, lactation
Physical: Skin color, temperature, lesions; orientation, reflexes, affect; P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R, adventitious sounds; liver evaluation, normal output; liver and renal function tests (IV); CBC, Hgb

Implementation



Drug-specific teaching points

Adverse effects in Italic are most common; those in Bold are life-threatening.