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nitroglycerin (glyceryl trinitrate)
Anginine‡, Deponit, Minitran, Nitradisc‡, Nitro-Bid, Nitro-Bid IV, Nitrocine, Nitrodisc, Nitro-Dur, Nitrogard, Nitrogard SR†, Nitroglyn, Nitrol, Nitrolingual, Nitrong, Nitrostat, Nitro-Time, NTS, Transderm-Nitro, Transiderm-Nitro‡, Tridil

Pregnancy Risk Category C

How supplied
Tablets (buccal):
1 mg, 2 mg, 3 mg
Tablets (S.L.):
0.15 mg (1/400 gr), 0.3 mg (1/200 gr), 0.4 mg (1/150 gr), 0.6 mg (1/100 gr)
Tablets (sustained-release):
2.6 mg, 6.5 mg, 9 mg, 13 mg
Capsules (sustained-release):
2.5 mg, 6.5 mg, 9 mg, 13 mg
Aerosol (translingual):
0.4 mg metered spray
Topical:
2% ointment
Transdermal:
0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg, 0.6 mg, 0.8 mg per hour release rate
Injection:
0.5 mg/ml, 5 mg/ml

Action
A nitrate that reduces cardiac oxygen demand by decreasing left ventricular end-diastolic pressure (preload) and, to a lesser extent, systemic vascular resistance (afterload). Also increases blood flow through the collateral coronary vessels.

Indications & dosage
Prophylaxis against chronic anginal attacks
--
Adults:
2.5 or 2.6 mg sustained-release capsule or tablet q 8 to 12 hours, adjusted upward to an effective dose in 2.5- or 2.6-mg increments b.i.d. to q.i.d. Or, use 2% ointment: Start dosage with 1/2-inch ointment, increasing by 1/2-inch increments until desired results are achieved. Range of dosage with ointment is 1/2 to 5 inches. Usual dose is 1 to 2 inches. Or, transdermal disc or pad (Nitrodisc, Nitro-Dur, or Transderm-Nitro) 0.2 to 0.4 mg/hour once daily.
Acute angina pectoris, prophylaxis to prevent or minimize anginal attacks before stressful events
--
Adults:
1 S.L. tablet (gr 1/400, 1/200, 1/150, 1/100) dissolved under the tongue or in the buccal pouch as soon as angina begins. Repeat q 5 minutes, if needed, for 15 minutes. Or, using Nitrolingual spray, one or two sprays into mouth, preferably onto or under the tongue. Repeat q 3 to 5 minutes, if needed, to a maximum of three doses within a 15-minute period. Or, 1 to 3 mg transmucosally q 3 to 5 hours during waking hours.
Hypertension associated with surgery, heart failure associated with MI, angina pectoris in acute situations, to produce controlled hypotension during surgery (by I.V. infusion)
--
Adults:
initial infusion rate is 5 mcg/
minute, increased p.r.n. by 5 mcg/minute q 3 to 5 minutes until response occurs. If a 20 mcg/minute rate doesn't produce a response, may increase dosage by as much as 20 mcg/minute q 3 to 5 minutes. Up to 100 mcg/minute may be needed.

Adverse reactions
CNS:
headache, dizziness, weakness.
CV:
orthostatic hypotension, tachycardia, flushing, palpitations, fainting.
GI:
nausea, vomiting.
Skin:
cutaneous vasodilation, contact dermatitis (patch), rash.
Other: hypersensitivity reactions,
sublingual burning.

Interactions
Drug-drug.
Antihypertensives: possible enhanced hypotensive effect. Monitor closely.
Heparin:
I.V. nitroglycerin interferes with anticoagulant effect of heparin in some patients. Monitor PTT.
Sildenafil:
may increase risk of hypotension. Avoid concomitant use.
Drug-lifestyle.
Alcohol use: possible increased hypotension. Avoid alcohol intake.

Effects on diagnostic tests
Nitroglycerin may interfere with serum cholesterol determination tests using the Zlatkis-Zak color reaction, resulting in falsely decreased values.

Contraindications
Contraindicated in patients with early MI, severe anemia, increased intracranial pressure, angle-closure glaucoma, orthostatic hypotension, allergy to adhesives (transdermal), or hypersensitivity to nitrates. I.V. nitroglycerin is contraindicated in patients with hypersensitivity to I.V. form, cardiac tamponade, restrictive cardiomyopathy, or constrictive pericarditis.

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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