Dosing & Uses
Not available in US
Angina Pectoris (Treatment & Prevention)
10-20 mg PO QID, may increase to 40 mg PO QID
Erythrityl Tetranitrate (Cardilate)
10 mg PO/SL PRN to no more than 100 mg/day
Take 1/2 hour before or 1 hour after meals and at bedtime
SR: 80 mg PO BID on empty stomach
Not FDA approved in children
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Flushing, hypotension, postural hypotension, tachycardia
Recent (last 24 hr) Sildenafil (Viagra) or other PDE5 inhibitor use: potential for dangerous hypotension
Alcohol use, glaucoma, head trauma, cerebral hemorrhage, hyperthyroidism, hypertrophic cardiomyopathy, incr ICP, incr IOP, postural hypotension, volume depletion, recent MI
Discontinue if blurred vision develops
Gradually decr dose to avoid withdrawal rxn
May need 10-12 hr/d nitrate-free interval to avoid tolerance development
Pregnancy & Lactation
Pregnancy Category: C
Lactation: not known whether the drug crosses into breast milk, use caution
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Onset: immediate release: 20-60 min
Immediate release: 5 hr
SR: 12 hr
Metabolism: extensively metabolized in liver
Metabolites: pentaerythritol trinitrate, pentaerythritol dinitrate, pentaerythritol mononitrate, & pentaerythritol (inactive)
Excretion: mainly in urine
Mechanism of Action
Organic nitrate which causes systemic venodilation, decreasing preload.
Cellular mechanism: nitrate enters vascular smooth muscle and converted to nitric oxide (NO) which acts as a cellular messenger leading to activation of cGMP and vasodilation