Adult Dosing
Acute angina pectoris
nitroglycerine (SL TAB), Nitrostat
- 0.3-0.6 mg sublingually/buccally for q5 min; Max: 3 tabs in a 15 min period
- Provide immediate emergency medical services if pain persists even after 15 min
Prophylaxis of angina pectoris
nitroglycerine (SL TAB), Nitrostat
- 0.3-0.6 mg single dose 5 to 10 min before activity that might precipitate an anginal attack
nitroglycerine (ECAPS)
Note Follow 10 to 12 hr nitroglycerin free intervals of to prevent tolerance
Autonomic Dysreflexia (Non-FDA Approved)
- 300-400 mcg sublingual by tablet or spray q5 minutes as needed
Cardiogenic Pulmonary Edema (Non-FDA Approved)
- 0.3-0.6 mg sublingually q 5 mins, may repeat as needed and as blood pressure allows (can cause hypotension). If ongoing dosing is required, consider initiating IV infusion of nitroglycerin
Acute Coronary Syndromes [Non-FDA Approved]
- 300-600 mcg SL PRN q3-5 mins to maximium 3 doses
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
See Supplemental Patient Information
- Efficacy of sublingual nitroglycerin in acute myocardial infarction or CHF has not been established. Monitor carefully clinical and hemodynamic parameters if sublingual nitroglycerin is used in such conditions as it causes hypotension and tachycardia. Capsules are not recommended
- Nitroglycerin tablets should not be swallowed, it is only for sublingual or buccal administration
- Even small doses can cause severe hypotension, particularly in upright posture. Use cautiously in patients who may be volume-depleted or already hypotensive
- Hypotension induced by nitroglycerin is accompanied by paradoxical bradycardia and increased angina pectoris
- Aggravates the angina caused by hypertrophic cardiomyopathy
- Blunt exercise tolerance is observed with sublingual nitroglycerin therapy
- Long term exposure to nitroglycerin demonstrates physical dependence and causes chest pain, acute myocardial infarction, and even sudden death during temporary withdrawal
- Development of tolerance is possible with sublingual nitroglycerin in patients who maintain continuous high dose of nitrates for more than 10-12 hrs daily
- Discontinue the drug if blurring of vision or dry mouth occurs
- Excessive dosage of nitroglycerin causes severe headache
Cautions: Use cautiously in
- Volume depletion
- Hypotension
- Acute MI
- CHF
- Malabsorption
- GI Hypermotility
- Cerebral hemorrhage
- Geriatric population
- Idiopathic hypertrophic subaortic stenosis
- Head injury
Supplemental Patient Information
- Do not chew, crush, or swallow; for sublingual use only
- If chest pain persist even after total of 3 tablets in a 15-minute period, prompt medical attention is advised
- While taking the drug, patient should preferably be in the sitting position and should use caution when returning to a standing position
Pregnancy Category:B
Breastfeeding: Safety unknown, Sublingual nitroglycerin has not been studied during breastfeeding. After breastfeeding observe the infants for flushing and discomfort. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 9th December 2010). However manufacturer advises caution as many drugs are excreted in human milk
US Trade Name(s)
US Availability
nitroglycerin (generic)
- ECAPS: 2.5, 6.5, 9 mg
- SL TABS: 0.3, 0.4, 0.6 mg
Nitrostat
- SL TABS: 0.3, 0.4, 0.6 mg
Canadian Trade Name(s)
Canadian Availability
Nitrostat
UK Trade Name(s)
UK Availability
glyceryl trinitrate(generic)
- SL TABS: 0.3, 0.5, 0.6 mg
Suscard
Australian Trade Name(s)
- Anginine
- Lycinate
- Nitrostat
Australian Availability
Anginine
Lycinate
Nitrostat
Pricing data from www.DrugStore.com in U.S.A.
- Nitrostat 0.6 MG SUBL [Bottle] (PFIZER U.S.)
100 mg = $25.99
300 mg = $55.97 - Nitrostat 0.3 MG SUBL [Bottle] (PFIZER U.S.)
100 mg = $25.99
300 mg = $57.97 - Nitrostat 0.4 MG SUBL [Bottle] (PFIZER U.S.)
25 mg = $20.99
75 mg = $39.95 - Nitrostat 0.4 MG SUBL [Bottle] (PFIZER U.S.)
100 mg = $27.99
300 mg = $56.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
