Dosing & Uses
Dosage Forms & Strengths
ointment
- 2%
Angina Pectoris (Long-Term Prophylaxis)
0.5-2 inches applied in am and 6 hours later to truncal skin
Congestive Heart Failure
1.5 inches, increase by 0.5-1 inch up to 4 inches, q4hr
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (11)
- avanafil
nitroglycerin topical, avanafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.
- bromocriptine
bromocriptine decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.
- cabergoline
cabergoline decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.
- dihydroergotamine
dihydroergotamine decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.
- dihydroergotamine intranasal
dihydroergotamine intranasal decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.
- ergoloid mesylates
ergoloid mesylates decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.
- ergotamine
ergotamine decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.
- methylergonovine
methylergonovine decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.
- sildenafil
nitroglycerin topical, sildenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.
- tadalafil
nitroglycerin topical, tadalafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.
- vardenafil
nitroglycerin topical, vardenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.
Serious - Use Alternative (5)
- cabergoline
nitroglycerin topical increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.
- ergoloid mesylates
nitroglycerin topical increases effects of ergoloid mesylates by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.
- ergotamine
nitroglycerin topical increases effects of ergotamine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.
- lofexidine
lofexidine, nitroglycerin topical. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
- methylergonovine
nitroglycerin topical increases effects of methylergonovine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.
Monitor Closely (4)
- arginine
nitroglycerin topical, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.
- bretylium
nitroglycerin topical, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.
- bupivacaine implant
nitroglycerin topical, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.
- tetracaine
tetracaine, nitroglycerin topical. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
Minor (3)
- acetylcysteine
acetylcysteine increases effects of nitroglycerin topical by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.
- acetylcysteine (Antidote)
acetylcysteine (Antidote) increases effects of nitroglycerin topical by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.
- ethanol
nitroglycerin topical, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.
Adverse Effects
Frequency Not Defined
Headache
Hypotension
Tachycardia
Dizziness
Lightheadedness
Blurred vision
Flushing
Nausea/vomiting
Nervousness
Xerostomia
Topical allergic reactions
Serious
- Methemoglobinemia (rare)
- Syncope
- Prolonged bleeding time
- Exfoliative dermatitis
- Unstable angina
- Rebound hypertension
- Thrombocytopenia
Warnings
Contraindications
Hypersensitivity to organic nitrates
Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil)
Riociguat; coadministration may cause hypotension
Cautions
Use caution in alcohol use, increased ICP (head trauma, cerebral hemorrhage-potential contraindication), hyperthyroidism, hypertrophic cardiomyopathy, increased IOP, hypotension, volume depletion, or 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
Discontinue if blurred vision develops
Do not apply with fingers; do not rub or massage
Use supportive treatment in overdose
Amplification of vasodilatory effects of nitroglycerin by sildenafil can result in severe hypotension; time course and dose dependence of this interaction not studied; appropriate supportive care has not been studied, but seems reasonable to treat this as a nitrate overdose, with elevation of extremities and with central volume expansion
Benefits of transdermal nitroglycerin in patients with acute myocardial infarction or congestive heart failure not established; if one elects to use nitroglycerin in these conditions, use careful clinical or hemodynamic monitoring to avoid hazards of hypotension and tachycardia
Severe hypotension, particularly with upright posture, may occur with even small doses; use drug with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive; hypotension induced by therapy may be accompanied by paradoxical bradycardia and increased angina pectoris
Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy
Effect of therapy on exercise tolerance, although still observable, may become somewhat blunted; in industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance clearly occurs; chest pains, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates from these workers, demonstrating existence of true physical dependence
During nitrate-free intervals in some clinical trials, anginal attacks have been more easily provoked than before treatment, and patients have demonstrated hemodynamic rebound and decreased exercise tolerance; importance of these observations to routine, clinical use of transdermal nitroglycerin not known
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.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
Half-Life elimination: 1-4 min
Antianginal effects: 30 min
Hemodynamic effects: Within 1 hr
Duration antianginal effects: Up to 7 hr (topical)
Hemodynamic effects: 3-6 hr
Peak Plasma Time: 3-4 hr
Protein Bound: 60%
Vd: 3 L/kg
Metabolism: Mainly in liver, extrahepatic sites: vascular wall, RBC
Metabolites: 1,3-glyceryl dinitrate, 1,2-glyceryl dinitrate, and glyceryl mononitrate (inactive)
Clearance: 5.5-11 L/min
Excretion: Urine
Dialyzable: No
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| nitroglycerin intravenous - | 50 mg/10 mL (5 mg/mL) vial |  | |
| Rectiv rectal - | 0.4 % (w/w) ointment |  | |
| nitroglycerin transdermal - | 0.4 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.6 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.2 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.1 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.6 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.4 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.2 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.4 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.6 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.2 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.2 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.6 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.4 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.4 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.2 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.1 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.1 mg/hr transdermal system |  | |
| nitroglycerin oral - | 2.5 mg capsule |  | |
| nitroglycerin oral - | 9 mg capsule |  | |
| nitroglycerin oral - | 6.5 mg capsule |  | |
| Nitro-Dur transdermal - | 0.3 mg/hr transdermal system |  | |
| Nitro-Time oral - | 9 mg capsule | | |
| Nitro-Time oral - | 6.5 mg capsule | | |
| Nitro-Time oral - | 2.5 mg capsule | | |
| nitroglycerin translingual - | 400 mcg/spray solution |  | |
| nitroglycerin translingual - | 400 mcg/spray solution |  | |
| nitroglycerin sublingual - | 0.6 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.3 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.6 mg tablet |  | |
| nitroglycerin sublingual - | 0.6 mg tablet |  | |
| nitroglycerin sublingual - | 0.3 mg tablet |  | |
| nitroglycerin sublingual - | 0.6 mg tablet |  | |
| nitroglycerin sublingual - | 0.3 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| Nitrostat sublingual - | 0.4 mg tablet | | |
| Nitrostat sublingual - | 0.6 mg tablet |  | |
| Nitrostat sublingual - | 0.4 mg tablet |  | |
| Nitrostat sublingual - | 0.3 mg tablet | | |
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Nitrolingual translingual - | 400 mcg/spray solution |  | |
| Nitromist translingual - | 400 mcg/spray aerosol |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
nitroglycerin intravenous
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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