nitroglycerin; NTG; TNG (Tridil, NitroBid, Nitrol, Nitrostat, Deponit, Minitran, NitroDur, Nitropaste, Rectiv)

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Indications

Contraindications

Caution:

pregnancy category = c

safety in lactation = ?

Dosage

  • IV (infusion): Tradenames: Tridil, NitroBid.
  • ointment
    • 2% (Nitropaste): Tradenames Nitro-bid, Nitrol.
      • 0.5-5 inches every 4-8 hours
      • remove every 8/day (to avoid tolerance)
      • (15 mg/inch). (30 g, 60 g)
    • 0.2% & 0.4% (Reactiv) for anal fissures[9]
  • sublingual: Tradename: Nitrostat.
    • 0.4 mg SL (if no relief after 5 min, call 911)[7]
  • sustained-release: Tradename: NitroBid.
  • spray: Tradename: Nitrolingual.
    • 1-2 oral sprays PRN.
  • transdermal:
    • 1 patch QD.
    • Deponit: 0.2, 0.4 mg/hr.
    • Minitran: 0.1, 0.2, 0.4, 0.6 mg/hr.
    • Nitro-Dur: 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hr.
    • Nitrodisc: 0.2, 0.3, 0.4 mg/hr.
    • Transderm-Nitro: 0.1, 0.2, 0.4,0.6, 0.8 mg/hr.

Conversion: ointment < 1 inch patch 0.4 mg/hr dinitrate 20 mg TID

Injection: 5 mg/mL (10 mL)

Tabs: (sublingual) 0.15, 0.4, 0.4, 0.6 mg. {tablets useable until expiration date}[6][7]

Tabs: (sustained-release) 2.5, 6.5, 9 mg.

Storage

  • store in orginal container (reason unclear)[10]

Pharmacokinetics

  • onset of action
    • immediately following IV administration
    • within 2 minutes after sublingual administration
    • 20-40 minutes after SR capsule
    • 15-60 minutes after application of ointment
    • 30-60 minutes after application of patch
  • peak effect
    • immediately following IV administration
    • within 4-8 minutes after sublingual administration
    • 45-120 minutes after SR capsule
    • 30-120 minutes after application of ointment
    • 60-180 minutes after application of patch
  • duration of action
    • 3-5 minutes following IV administration
    • 30-60 minutes after sublingual administration
    • 4-8 hours after SR capsule
    • 2-12 hours after application of ointment
    • 18-24 hours after application of patch
  • extensive 1st pass metabolism limits systemic absorbtion
  • metabolized by liver
  • long-term administration may saturate metabolic capacity of the liver, resulting in accumulation & tolerance
  • 1/2life is 2-3 hours

elimination via liver

1/2life = 1-3 minutes

Adverse effects

Drug interactions

Mechanism of action

Notes

  • Nitroglycerin was first synthesized in 1846 by Sobero, who observed that a small quantity of the oily substance placed on the tongue elicited a severe headache[1]
    • In 1879, William Murrell established the use of sublingual nitroglycerin for relief of acute angina.

More general terms

References

  1. 1.0 1.1 Gilman et al, eds. Permagon Press/McGraw Hill pg 764
  2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 87,131
  3. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  4. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  5. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  6. 6.0 6.1 Prescriber's Letter 10(6):33 2003
  7. 7.0 7.1 7.2 Prescriber's Letter 12(9): 2005 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211102&pb=PRL (subscription needed) http://www.prescribersletter.com
  8. Prescriber's Letter 17(5): 2010 COMMENTARY: Sublingual Nitroglycerin GUIDELINES: Management of Patients with Unstable Angina/ Non-ST-Elevation Myocardial Infarction (ACC/AHA, 2007) GUIDELINES: Management of Patients with ST-Elevation Myocardial Infarction (ACC/AHA, 2004) PATIENT HANDOUT SPANISH VERSION: Lo que usted debe saber acerca de su nitroglicerina de uso sublingual PATIENT HANDOUT: What You Should Know About Your Sublingual Nitroglycerin Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260503&pb=PRL (subscription needed) http://www.prescribersletter.com
  9. 9.0 9.1 Deprecated Reference
  10. 10.0 10.1 Prescriber's Letter 21(6): 2014 Oral Meds to Keep in Original Containers Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300622&pb=PRL (subscription needed) http://www.prescribersletter.com

Database