Adult Dosing
Perioperative hypertension
- Initial: Start 5 mcg/min IV
- Titrate: Increase 5 mcg/min q3-5 mins until desired response
- If no response until 20 mcg/min, increase the dosage by 10-20 mcg/min q3-5 mins
- Once response observed, reduce the dose and lengthen the interval between increases
Congestive heart failure in the setting of acute myocardial infarction
- Initial 5 mcg/min IV, then increase 5 mcg/min q3-5 min until desired response
- If no response until 20 mcg/min, increase the dosage by 10-20 mcg/min q3-5 min
- Once response observed, reduce the dose and lengthen the interval between increases
Angina pectoris
- Initial 5 mcg/min IV, then increase 5 mcg/min q3-5 min until desired response
- If no response until 20mcg/min, increase the dosage by 10-20 mcg/min q3-5 min
- Once response observed reduce the dose and lengthen the interval between increases
Note:
- Not for direct intravenous injection, dilute in dextrose (5%) injection or sodium chloride (0.9%) injection prior to its infusion
- Do not mix with other drugs
Autonomic Dysreflexia (Non-FDA Approved)
- Start 5-10 mcg/minute IV infusion; titrate up to 100 mcg/minute
Cardiogenic Pulmonary Edema (Non-FDA Approved)
- Start at 5-10 mcg/min and increase every 5-10 minutes by 5 mcg/min as needed and as blood pressure allows (can cause hypotension)
Acute Coronary Syndromes [Non-FDA Approved]
- 5-10 mcg/min IV, increased by 10 mcg/min q3-5 mins until pain resolved or limited by hypotension
Hypertensive Emergency [Non-FDA approved]
- Continuous IV infusion: 5 mcg/min IV, then increase q3-5 min PRN by 5 mcg/min up to 20 mcg/min
- If inadequate response, increase by 10 mcg/min q3-5 min PRN up to a max. of 200 mcg/min
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Autonomic Dysreflexia (Non-FDA Approved)
- Start 0.25–0.5 mcg/kg/minute IV infusion; increase by 0.5–1 mcg/kg/minute q3–5 min PRN. Max: 5 mcg/kg/minute
[Outline]
- Avoid concomitant use with sildenafil as it may induce severe hypotension, duration and dose dependence of this interaction has not been established. Provide appropriate treatment as it would be for nitrate overdose, with elevation of the extremities and volume expansion
- Use product with the least absorptive infusion tubing i.e.non-PVC tubing as absorption of nitroglycerine by PVC tubing occurs
- Follow dosing instructions with utmost care. Use appropriate infusion sets as actual dose of nitroglycerine will be delivered
- Severe hypotension with paradoxical bradycardia, increased angina pectoris and shock have occurred even with low doses, administer drug cautiously in patients who are volume depleted or are already hypotensive
- Angina caused by hypertropic cardiomyopathy is aggravated by nitrate therapy
- Long-term exposure to unknown (presumably high) doses of organic nitrates develops tolerance and temporary withdrawal of nitrates leads to chest pain, acute myocardial infarction, and even sudden death, demonstrating the drug dependence
- Use of lower concentration increases potential for precise dosing but increases the total fluid volume to be delivered, which is a dominant consideration in patients with compromised function of the heart, liver or kidneys. Administer infusions only via a pump that can maintain a constant infusion rate
- Intracoronary injection of nitroglycerin infusions is not studied
- Serum triglyceride assays relying on glycerol oxidase may give falsely elevated results due to presence of propylene glycol in the product
- Continuously monitor blood pressure, heart rate in all patients and other measurements such as pulmonary, capillary wedge pressure to achieve the correct dose
- Systemic blood pressure and coronary perfusion pressure must be maintained adequately
- Carefully monitor and titer the dose in patients with normal or low left ventricular filling pressures or pulmonary capillary wedge pressure
Cautions: Use cautiously in
Pregnancy Category:C
Breastfeeding: Safety unknown; Intravenous nitroglycerin have not been studied during breastfeeding. Observe infants for flushing and discomfort after breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 8th December 2010). However manufacturer advices caution.
US Trade Name(s)
US Availability
nitroglycerin (generic)
- INJ: 5 mg/mL (5 mL/vial)
- INJ (with 5% dextrose): 10 mg/100 mL
- INJ (with 5% dextrose): 20 mg/100 mL
- INJ (with 5% dextrose): 40 mg/100 mL
Canadian Trade Name(s)
Canadian Availability
nitroglycerin (generic)
- INJ: 5 mg/mL
- INJ (with 5% dextrose): 100 mcg/mL
- INJ (with 5% dextrose): 200 mcg/mL
- INJ (with 5% dextrose): 400 mcg/mL
Nitroject
UK Trade Name(s)
UK Availability
nitroglycerin (generic)
- INJ: 0.5 mg/mL
- INJ: 1 mg/mL
- INJ: 5 mg/mL
Nitrocine
- INJ: 1 mg/mL (10, 50 mL vials)
Nitronal
Australian Trade Name(s)
Australian Availability
glyceryl trinitrate (generic)
[Outline]