| name | Nitroglycerin |
| Classification | Nitrate vasodilator, Antianginal |
| Pharmacokinetics | Nitroglycerin is rapidly absorbed, primarily via the mucous membranes (sublingual, buccal). It undergoes significant first-pass metabolism in the liver, resulting in a short duration of action. Metabolites are primarily excreted in the urine. Bioavailability can vary depending on the route of administration (e.g., sublingual, topical). Significant hepatic metabolism limits oral absorption and thus the oral form is usually used for prophylaxis and less for acute attacks. |
| suggested dosage | | sublingual | 0.4 mg tablet, as needed for angina attacks. May repeat every 5 minutes up to 3 doses if needed. Must be taken at home and have follow up with the physician if symptoms do not resolve. Do not take more than 3 tablets if symptoms persist or worsen. | | oral | 5-10 mg every 4-6 hours, as needed. The dosage may be adjusted based on response and tolerance. | | transdermal | Depending on the strength of patch/ointment. Consult physician or pharmacist. | | other routes | Consult physician for IV/other routes. |
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| indications | | 1 | Prevention and treatment of angina pectoris (chest pain due to insufficient blood flow to the heart). | | 2 | Management of acute hypertensive crisis (severe high blood pressure). | | 3 | Treatment of congestive heart failure (in severe cases) |
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| Safety in pregnancy | Nitroglycerin use during pregnancy should be evaluated on a case-by-case basis. The potential benefits should be weighed against the potential risks to the mother and fetus. Use only under the direct supervision of a physician. |
| Safety in breastfeeding | Nitroglycerin is considered possibly safe in breastfeeding women. However, the drug and/or its metabolites may be present in breast milk and the potential effects on the infant should be carefully considered. |
| side effects | | 1 | Headache (common, often a sign of efficacy, resolves in most cases) | | 2 | Flushing | | 3 | Dizziness | | 4 | Lightheadedness | | 5 | Fainting | | 6 | Tachycardia (rapid heartbeat) | | 7 | Hypotension (low blood pressure), | | 8 | Nausea | | 9 | Vomiting | | 10 | Tolerance and tachyphylaxis (reduced response to medication with repeated use). |
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| alternatives | |
| contraindications | | 1 | Hypersensitivity to nitroglycerin or other nitrates | | 2 | Severe hypotension | | 3 | Closed-angle glaucoma | | 4 | Concurrent use of phosphodiesterase inhibitors (e.g., sildenafil, tadalafil, vardenafil; Viagra, Cialis, Levitra) – can cause severe hypotension. | | 5 | Patient on certain medications |
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| interactions | | 1 | Combining nitroglycerin with alcohol or other CNS depressants could increase the risk of hypotension. | | 2 | The use of phosphodiesterase-5 inhibitors (PDE5-inhibitors) with nitrates can cause a sudden and significant drop in blood pressure, and should be avoided unless a physician specifically advises otherwise. |
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| warnings and precautions | | 1 | Patients should be monitored for signs and symptoms of hypotension, especially after initial administration. | | 2 | Proper storage of nitroglycerin is crucial to ensure its potency. | | 3 | Nitroglycerin should be used with caution in patients with severe heart conditions. | | 4 | A gradual dose increase is preferred for prevention and maintenance of medication. | | 5 | Ensure proper storage conditions for medications and take the drug as prescribed by the doctor. |
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| additional informations | Patients should be instructed on how to use the medication correctly and what to look for and what to do if there are issues. Always consult with a physician to get accurate information. |
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