Nitroglycerin: Difference between revisions
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==General== | ==General== | ||
*Type: stimulates cGMP production causing vascular smooth muscle relaxation | *Type: vasodilator; stimulates cGMP production causing vascular smooth muscle relaxation | ||
*Dosage Forms: SL, IV | *Dosage Forms: SL, IV | ||
*Common Trade Names: Nitrolingual, NitroMist, Nitrostat | *Common Trade Names: Nitrolingual, NitroMist, Nitrostat | ||
==Adult Dosing== | ==Adult Dosing== | ||
===Angina, acute=== | |||
* | *0.3 - 0.6mg SL q5min, max: 3 doses within 15 min | ||
*IV form: 5 mcg/min IV, increase 5-20 mcg/min q3-5min. | |||
===[[Hypertension]]=== | |||
*5-200 mcg/min IV, start 5 mcg/min IV and increase 5 mcg/min q3-5min | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===[[Hypertension]]/[[CHF]]=== | |||
*1-5 mcg/kg/min IV, start 0.25-0.5 mcg/kg/min, max: 20 mcg/kg/min | |||
==Special Populations== | ==Special Populations== | ||
| Line 23: | Line 28: | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*Pericardial tamponade | |||
*Severe anemia | |||
*[[Sildenafil]] use within the past 24 hours or tadalafil within the past 48 hours<ref>Kloner RA, Hutter AM, Emmick JT, Mitchell MI, Denne J, Jackson G. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003 Nov 19;42(10):1855-60.</ref><ref>Cheitlin MD, Hutter AM Jr, Brindis RG, et al. ACC/AHA/[https://nizagara-online.net Nizagara-online.net] expert consensus document: use of sildenafil (Viagra) in patients with cardiovascular disease: American College of Cardiology/American Heart Association. J Am Coll Cardiol 1999;33:273-82.</ref> | |||
*[[Methemoglobinemia]] | |||
*Caution in hypotension | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*hypotension | |||
*bradycardia | |||
*methemoglobinemia | |||
===Common=== | ===Common=== | ||
*headache | |||
*dizziness | |||
*flushing | |||
*hypotension | |||
*reflex tachycardia | |||
*edema | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 1-3 min | ||
*Metabolism: | *Metabolism: liver, erythrocytes, vascular walls | ||
*Excretion: | *Excretion: urine | ||
*Mechanism of Action: | *Mechanism of Action: stimulates cGMP production resulting in vascular smooth muscle relaxation | ||
==Indications by Condition== | |||
''The following table is automatically generated from disease/condition pages across WikEM.'' | |||
{{#ask:[[Has DrugName::Nitroglycerin]] | |||
|?Has Indication=Indication | |||
|?Has Dose=Dose | |||
|?Has Context=Context | |||
|?Has Route=Route | |||
|?Has Population=Population | |||
|format=table | |||
|headers=plain | |||
|mainlabel=- | |||
|sort=Has Indication | |||
|limit=50 | |||
}} | |||
==See Also== | ==See Also== | ||
== | ==External Links== | ||
*[https://emcrit.org/emcrit/scape/ EMCrit: Sympathetic Crashing Acute Pulmonary Edema (SCAPE)] | |||
==References== | |||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:Cardiology]] | |||
Latest revision as of 21:56, 20 March 2026
General
- Type: vasodilator; stimulates cGMP production causing vascular smooth muscle relaxation
- Dosage Forms: SL, IV
- Common Trade Names: Nitrolingual, NitroMist, Nitrostat
Adult Dosing
Angina, acute
- 0.3 - 0.6mg SL q5min, max: 3 doses within 15 min
- IV form: 5 mcg/min IV, increase 5-20 mcg/min q3-5min.
Hypertension
- 5-200 mcg/min IV, start 5 mcg/min IV and increase 5 mcg/min q3-5min
Pediatric Dosing
Hypertension/CHF
- 1-5 mcg/kg/min IV, start 0.25-0.5 mcg/kg/min, max: 20 mcg/kg/min
Special Populations
- Pregnancy Rating: C
- Lactation: safety unknown
- Renal Dosing
- Adult: no adjustment
- Pediatric: no adjustment
- Hepatic Dosing
- Adult: not defined
- Pediatric: not defined
Contraindications
- Allergy to class/drug
- Pericardial tamponade
- Severe anemia
- Sildenafil use within the past 24 hours or tadalafil within the past 48 hours[1][2]
- Methemoglobinemia
- Caution in hypotension
Adverse Reactions
Serious
- hypotension
- bradycardia
- methemoglobinemia
Common
- headache
- dizziness
- flushing
- hypotension
- reflex tachycardia
- edema
Pharmacology
- Half-life: 1-3 min
- Metabolism: liver, erythrocytes, vascular walls
- Excretion: urine
- Mechanism of Action: stimulates cGMP production resulting in vascular smooth muscle relaxation
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Congestive heart failure | 0.4 mg SL q5min x3; or IV drip start 10-20 mcg/min, titrate to BP (keep >95) | Preload/afterload reduction (1st line for hypertensive HF) | SL/IV drip | Adult |
| Flash pulmonary edema | 800mcg IV load over 2 min, then 100mcg/min maintenance (titrate up PRN) | High-dose NTG for vasodilation; may start at 100mcg/min then rapidly titrate to 400mcg/min for 2 min | IV | Adult |
| Flash pulmonary edema | 0.4mg SL q5min while setting up IV drip | Interim nitroglycerin while IV drip is being prepared | SL | Adult |
| Hypertensive emergency | 5-200 mcg/min | Antihypertensive (preload reduction) | IV drip | Adult |
| Non-ST-elevation myocardial infarction | 0.4mg SL q5min x3, then IV infusion if ongoing ischemia | Decrease preload; use cautiously in inferior MI or with sildenafil | SL/IV | Adult |
| Pulmonary edema | 0.4mg SL q5min, or IV starting 50mcg/min titrate rapidly to 150mcg/min+ | First-line vasodilator; reduce preload | SL/IV | Adult |
| ST-segment elevation myocardial infarction | 0.4 mg SL q5min x3 or IV drip titrated to pain relief | Vasodilator for ischemic pain | SL/IV | Adult |
| Unstable angina | 0.4mg SL q5min x3, then 5-200mcg/min IV if ongoing pain | Vasodilator for ischemia | SL/IV | Adult |
| Volume overload | 5mcg/min IV, titrate by 5-10mcg/min q5min (max 200mcg/min) | Vasodilator for acute pulmonary edema with hypertension | IV | Adult |
See Also
External Links
References
- ↑ Kloner RA, Hutter AM, Emmick JT, Mitchell MI, Denne J, Jackson G. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003 Nov 19;42(10):1855-60.
- ↑ Cheitlin MD, Hutter AM Jr, Brindis RG, et al. ACC/AHA/Nizagara-online.net expert consensus document: use of sildenafil (Viagra) in patients with cardiovascular disease: American College of Cardiology/American Heart Association. J Am Coll Cardiol 1999;33:273-82.