Nitroglycerin

Nitroglycerin

Patients using nitroglycerin regularly may have developed tolerance and require higher doses, alternatively nitroprusside to achieve desirable blood pressure lowring effect.

DrugNitroglycerin
Brand namesGonitro ®, Minitran ®, Mylan-nitro ®, Nitro-bid ®, Nitro-dur ®, Nitroject ®, Nitrolingual ®, Nitromist ®, Nitrostat ®, Rectiv ®, Trinipatch ®
IndicationsPulmonary edema, congestive heart failure.
Angina pectoris.
Hypertension, hypertensive crisis/emergency.
Pulmonary hypertension.
Blood pressure control.
Mechanism of actionNitroglycerin provides nitric oxide (NO) that induces vasodilatation (of both arterioles and veins) via generation of cyclic GMP, which then activates calcium-sensitive potassium channels in the cell membrane. Nitroglycerin is similar in action and pharmacokinetics to nitroprusside, although the latter is more potent.
EffectsAntihypertensive.
Antianginal.
Time to onset of action2 to 5 minutes
Duration of action5 to 10 minutes
DeliveryIV
DoseInitial infusion dose: 5 μg/min.
Increase by 5-10 μg/min every 5 min to desired blood pressure.
Maximum dose: 100 μg/min.
Time to onset of action: 2 to 5 minutes
Duration of action: 5 to 10 minutes.
Adverse effectsHeadache (cerebral vasodilation). Tachycardia (due to reflex sympathetic activation). Nausea. Vomiting. Flushing. Palpitations. Tolerance with prolonged use. Methemoglobinemia. Hypoxemia.
CautionProceed with caution in afterload-dependent conditions.
Nitroglycerin doses and administration in hypertension (hypertensive crisis/emergency).
Updated on 2025-01-18