nitroglycerin PO (Rx)

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Brand and Other Names:glyceryl trinitrate PO

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule, extended release

  • 2.5mg
  • 6.5mg
  • 9mg
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Angina Pectoris (Prophylaxis)

ER capsule: Initial 2.5-6.5 mg PO q6-8hr

Titrate up to effec dose until limited by SE

Renal Failure

CrCl: 10-50 mg/min: Administer q24-72hr

CrCl<10 mL/min: Administer q72-96hr

Not FDA approved

Angina Pectoris (Prophylaxis)

ER capsule: Initial 2.5-6.5 mg PO q6-8hrTitrate up to effec dose until limited by SE

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Interactions

Interaction Checker

and nitroglycerin PO

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Common

            Headache

            Hypotension

            Tachycardia

            Dizziness

            Lightheadedness

            Blurred vision

            Flushing

            N/V

            Nervousness

            Xerostomia

            Serious

            Methemoglobinemia (rare)

            Syncope

            Prolonged bleeding time

            Exfoliative dermatitis

            Unstable angina

            Rebound hypertension

            Thrombocytopenia

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            Warnings

            Contraindications

            Hypersensitivity, acute MI, severe anemia

            Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life

            Riociguat; coadministration may cause hypotension

            Narrow angle glaucoma (controversial: may not be clinically significant)

            Cautions

            MI or CHF, alcohol use, increased ICP (eg, head trauma, cerebral hemorrhage; potential contraindication), hyperthyroidism, hypertrophic cardiomyopathy, increased IOP, postural hypotension, volume depletion, low systolic BP

            Do not change brands unintentionally as not all are bioequivalent Treat drug-induced headache with aspirin or acetaminophen

            Provide nitrate-free interval (10-12 hr or overnight) to avoid development of tolerance

            Angina long term prophylaxis, NOT for acute relief

            Lack of burning/tingling does not indicate loss of potency

            Discontinue if blurred vision occurs

            Use supportive treatment in overdose

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known whether the drug crosses into breast milk, use caution

            Pregnancy Categories

            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.

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            Pharmacology

            Mechanism of Action

            Organic nitrate which causes systemic venodilation, decreasing preload

            Cellular mechanism: nitrate enters vascular smooth muscle and converted to nitric oxide (NO) leading to activation of cGMP & vasodilation

            Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial O2 demand  

            Also improves coronary collateral circulation. Lower BP, increase HR, occasional paradoxical bradycardia

            Pharmacokinetics

            onset: within 1- hr4

            Duration antianginal effects: Up to 12 hr

            Bioavailability: 38.5%

            Protein Bound: 11-60%

            Vd: 3 L/kg

            Metabolism: Liver, extrahepatic sites: vascular wall, RBC

            Metabolites: 1,3-glyceryl dinitrate, 1,2-glyceryl dinitrate, & glyceryl mononitrate (inactive)

            Clearance: 5.5-11 L/min

            Excretion: urine

            Dialyzable: No

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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