Nitroglycerin (Nitrostat, Nitrogard, Nitrolingual, Nitro-Bid, Nitrol, Nitro-Dur, Transderm-Nitro)

Category:

  • Miscellaneous

Description:

  • Antianginal (venous (predominantly) and arterial dilator)

Indications:

  • Acute angina, angina prophylaxis, perioperative hypertension, CHF associated with MI

  • Unresponsive angina pectoris

Contraindications:

  • Severe anemia, closed-angle glaucoma, postural hypotension, early MI, head trauma

  • Cerebral hemorrhage, hypotension, uncorrected hypovolemia, inadequate cerebral circulation, increased intracrainial pressure, constrictive pericarditis, pericardial tamponade (IV)

Precautions:

  • Pregnancy category C; may use SL for angina

  • Early days of MI, hypertrophic cardiomyopathy, severe hepatic/renal disease

  • Children, glaucoma, abrupt withdrawal, continuous delivery

Adverse Reactions (Side Effects):

  • CNS: agitation, anxiety, apprehension, confusion, dizziness, dyscoordination, headache, hypoesthesia, hypokinesia, insomnia, nervousness, nightmares, vertigo, restlessness

  • CV: atrial fibrillation, collapse, crescendo angina, dysrhythmias, palpitations, postural hypotension, PVCís, rebound hypertension, retrosternal discomfort, syncope, tachycardia

  • GI: abdominal pain, diarrhea, dyspepsia, fecal incontinence, nausea, tenesmus

  • GU: dysuria, impotence, urinary frequency

  • HEME: hemolytic anemia, methemoglobinemia

  • SKIN: allergic reactions (ointment), contact dermatitis (transdermal), crusty skin lesions, cutaneous vasodilation with flushing, exfloiative dermatitis, rash, sweating

Dosage:

Administered orally (spray, capsule, SL tablet, EC tablet, buccal tablet), topically (transdermal, ointment), and intravenously

  • Adult: 

    • BUCCAL 1mg every 3-5 hours while awake initially, titrate dosage upward if angina occurs with tablet in place

    • PO 2.5-9mg 2-4 times daily, up to 26mg 4 times daily;

    • IV 5 mcg/min via continuous infusion, increase by 5 mcg/min every 3-5 minutes to 20 mcg/min; if no response, increase by 10 mcg/min every 3-5 minutes up to 200 mcg min;

    • TOP 1-2 inches every 8 hours, up to 4-5 inches every 4 hours

    • TRANSDERMAL 0.2-0.4 mg/hr initially, titrate to 0.4-0.8 mg/hr; apply new patch daily; tolerance is minimized by removing patch for 10-12 hours daily

    • SL 0.2-0.6mg every 5 minutes for a max of 3 doses in 15 minutes; may also use prophylactically 5-10 minutes prior to activities that provoke angina attack

  • Child: 

    • IV 0.25-0.5 mcg/kg/min, titrate by 0.5-1 mcg/kg/min every 3-5 minutes as needed; usual dose 1-3 mcg/kg/min; max 20 mcg/kg/min

 

Special Considerations:

  • 10-12 hour drug-free intervals prevent development of tolerance

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