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. Jump up to: 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. Jump up to: 6.0 6.1 Prescriber's Letter 10(6):33 2003
  7. Jump up to: 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. Jump up to: 9.0 9.1 Deprecated Reference
  10. Jump up to: 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

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