Drug Cards

Nitroglycerin

Nitrolingual, Nitro-Dur
Class:
Vasodilator
Mechanism of Action:
Smooth muscle relaxant with dilation of arterioles and veins in the periphery, reduces preload and afterload, decreases the workload of the heart and, thereby, myocardial oxygen demand.
Indications:
  • Acute angina pectoris.
  • Ischemic chest pain.
  • CHF, pulmonary edema.
Contraindications:
  • Hypotension, hypovolemia.
  • Intracranial bleeding or head injury.
Adverse reactions:
Headache, hypotension, syncope, reflex tachycardia, flushing, nausea, vomiting, diaphoresis, muscle twitching.
Drug Interactions
Additive effects with other vasodilators.
Adult Dosage and Administration
  • Tablets: 0.4 mg SL; may repeat in 3-5 minutes to maximum of 3 doses. Vitals after every dose.
  • NTG spray: 0.4 mg under the tongue; for APE with HTN 1-2 sprays, may repeat in 3-5 minutes.
    No upper limit for LVF with pulmonary edema. Goal is to normalize blood pressure.
  • IV infusion with no prior NTG and SBP >160: 400 mcg bolus then infusion at 100 mcg/min; titrate infusion by 25 mcg/min q 3-5 min to dyspnea resolution.
  • IV infusion with prior NTG and SPB >160: 100 mcg/min infusion; titrate infusion by 25 mcg/min q 3-5 min to dyspnea resolution
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Pediatric Dosage and Administration:
Not recommended.
  • Onset: 1-3 minutes.
  • Peak effect: 5-10 minutes.
  • Duration: 20-30 minutes or if IV, 1-10 minutes after discontinuation of infusion.
Special Considerations:
  • Pregnancy safety: Category C
  • Hypotension more common in geriatric population.
  • NTG decomposes if exposed to light or heat.
  • Must be kept in airtight containers.
  • Active ingredient may have a stinging effect when administered SL.