nitroglycerin translingual (Rx)

Brand and Other Names:Nitrolingual, glyceryl trinitrate translingual spray, more...NitroMist
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

spray

  • 0.4mg/spray
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Angina

1-2 spray(s) PRN for angina, may repeat q3-5min, not to exceed 3 sprays in 15 minutes

Spray onto or under tongue; do not inhale, expectorate or rinse mouth for 5-10 minutes

Seek medical attention if pain persists after 3 doses in 15 minutes

Angina, Prophylaxis

1-2 sprays 5-10 minutes before activities likely to cause angina

Renal Failure

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

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

Not approved

Angina

Angina1-2 spray(s) PRN for angina, may repeat q3-5min, not to exceed 3 sprays in 15 minutes

Spray onto or under tongue; do not inhale, expectorate or rinse mouth for 5-10 minutes

Seek medical attention if pain persists after 3 doses in 15 minutes

Angina, prophylaxis

1-2 sprays 5-10 minutes before activities likely to cause angina

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Interactions

Interaction Checker

and nitroglycerin translingual

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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

            AMI, 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

            Soluble guanylate cyclase (sGC) stimulator, riociguat; coadministration may cause hypotension

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

            Increased intracranial pressure

            Circulatory failure or shock

            Cautions

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

            Severe hypotension may occur with small doses especially in patients with constrictive pericarditis, aortic or mitral stenosis, volume depleted patients or that are already hypotensive; hypotension may be accompanied by paradoxical bradycardia and/or increased angina pectoris

            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; excessive use my lead to development of tolerance

            Inability to relieve chest pain after 3 doses may mean AMI-rush to ER if possible

            Discontinue if blurred vision develops

            Prime pump prior to first use or after prolonged nonuse

            Use supportive treatment in overdose

            May aggravate the angina caused by hypertrophic obstructive cardiomyopathy

            Nitroglycerin produces dose-related headaches, especially at the start of nitroglycerin therapy, which may be severe and persistent but usually subside with continued use

            Dose selection for elderly should start at low end of dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known whether 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 & converted to nitric oxide (NO) leading to production 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

            Half-Life: 1-4 min

            Onset: 2 min

            Duration: Up to 1 hr

            Protein Bound: 11-60%

            Vd: 3 L/kg

            Metabolism: Mainly in 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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