Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: nitroglycerin, nitroglycerin translingual, nitroglycerin
transdermal, nitroglycerin intravenous, nitroglycerin topical
BRAND NAMES: Nitrostat, Nitroquick, Nitrolingual, Nitro-Dur, Minitran,
Nitro-Bid and others
DRUG CLASS AND MECHANISM: Nitroglycerin belongs to a class of drugs
called nitrates. Other nitrates include isosorbide dinitrate (Isordil) and
isosorbide mononitrate (Imdur, Ismo, Monoket). Nitroglycerin is used in the
management of angina pectoris (heart pain). Synthesized in 1846, nitroglycerin
was first used to treat anginal attacks in 1879. It was granted FDA approval in
1938.
Blood returning from the body in the veins must be pumped by the heart
through the lungs and into the arteries against the high pressure in the
arteries. In order to accomplish this work, the heart's muscle must produce and
use energy ("fuel"). The production of energy requires oxygen. Angina pectoris
(angina) or "heart pain" is due to an inadequate flow of blood (and oxygen) to
the muscle of the heart. It is believed that all nitrates, including
nitroglycerin, correct the imbalance between the flow of blood and oxygen to the
heart and the work that the heart must do by dilating (widening) the arteries
and veins in the body. Dilation of the veins reduces the amount of blood
returning to the heart so that the heart does less work and requires less blood
and oxygen. Dilation of the arteries also lowers the pressure in the arteries
against which the heart must pump. As a consequence, the heart works less and
requires less blood and oxygen.
Additionally, in patients with angina, nitroglycerin preferentially dilates
blood vessels that supply the areas of the heart where there is not enough
oxygen thereby delivering oxygen to the heart tissue that needs it most.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes (for some dosage forms)
PREPARATIONS:
- Tablets: 0.3, 0.4, 0.6 mg;
- Capsules: 2.5, 6.5, 9 mg;
Spray: 0.4 mg/spray;
- Transdermal Patch: 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hour;
- Ointment: 2%;
- Injection: 100, 200, 400 mcg/ml;
- Injection solution: 5 mg/ml.
STORAGE: All formulations should be kept at room temperature, 15-30 C
(59-86 F). The sublingual tablets are especially susceptible to moisture. They
should NOT be kept in bathrooms or kitchens because of the greater moisture in
these rooms. Care should be taken to replace the sublingual tablets every six
months.
PRESCRIBED FOR: Nitroglycerin is used for the treatment and prevention
of angina caused by coronary artery disease. Transdermal nitroglycerin,
nitroglycerin ointment and capsules do not act rapidly enough to be used for
acute angina attacks. Nitroglycerin also is used intravenously to treat
congestive heart failure associated with
myocardial infarction (heart
attack) and high blood
pressure during surgery.
DOSING: For the treatment of acute angina attacks or for acute
prevention (for example, immediately before encountering situations likely to bring on
an anginal attack), one tablet is allowed to dissolve under the tongue or in the
buccal pouch (between the cheek and gums), or one spray is given of the lingual
spray. Sublingual, spray and buccal nitroglycerin are rapidly absorbed from the
lining of the mouth for immediate effects. This may be repeated every 5 minutes
as needed. If angina is not relieved after a total of 3 doses, the patient
should be taken to a hospital or a physician should be contacted. If lingual
spray is used, the canister of spray should not be shaken prior to use, and it
should be sprayed onto or under the tongue and then the mouth closed.
For prevention of angina, ointment may be applied using special
dose-measuring application papers provided with the ointment. The usual dose is
1/2 to 2 inches applied every 4-6 hours. The appropriate amount of ointment is
squeezed as a thin layer onto the paper, and the paper is used to spread the
ointment onto a non-hairy area of the skin. The ointment should not be allowed
to come into contact with the hands so that absorption from the hands does not
occur.
Transdermal patches also are used for prevention. The usual dose is
0.2-0.8 mg/hr applied for 12 hours and then removed. An additional 12 hours
should be allowed before applying the next patch because a 12 hour nitroglycerin
free period reduces the occurrence of tolerance to the effects (reduced
effectiveness) of nitroglycerin. Patches may be applied to any hairless site but
should not be applied to areas with cuts or calluses which can alter absorption.
Firm pressure should be used over the patch to ensure contact with the skin. The
patch should not be cut or trimmed. Patches are waterproof and should not be
affected by showering or bathing.
Capsules of long-acting nitroglycerin also are
used for prevention. The usual dose is 2.5-9 mg administered 2 to 3 times per
day 1 to 2 hours after a meal. Capsules should be swallowed whole and not
chewed.
DRUG INTERACTIONS: Since nitroglycerin can cause hypotension (low
blood pressure), other medications which also cause hypotension may produce
severe hypotension. Such drugs might include medicines used to treat high blood
pressure, some antidepressants; some anti-psychotics, quinidine
(Quinaglute, Quinidex), procainamide
(Pronestyl, Procan-SR, Procanbid),
benzodiazepines such as diazepam (Valium) or opiates,
for example, morphine. Since
alcohol also may intensify the blood pressure lowering effect of nitroglycerin,
patients receiving nitroglycerin should be advised to drink alcoholic beverages
with caution.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- isosorbide dinitrate, Isordil Titradose, Dilatrate-SR, Isochron - Drug information on isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron), a nitrate prescribed for angina, heart pain, and congestive heart failure.
- Congestive Heart Failure - Read about congestive heart failure symptoms like fatigue, abdomen, leg and ankle swelling, shortness of breath, sleeplessness, increased urination, nausea, abdominal pain, and decreased appetite.
- isosorbide mononitrate, Imdur, Ismo, Monoket - Information on the drug isosorbide mononitrate (Imdur, Ismo, Monoket), a nitrate used to treat angina pectoris (heart pain, chest pain). Side effects, drug interactions, and warnings and precautions are included in the information.
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