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Clinical Practice Guidelines
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Nitroglycerin

Classification

Antianginal

Indications

EMR: Relief from chest pain suggestive of acute coronary syndrome

ACP: Reduction of blood pressure in acute cardiogenic pulmonary edema

Contraindications

Known allergy or hypersensitivity to nitroglycerin
Use of Viagra (sildenafil) or Levitra (vardenafil) within the previous 24 hours
Use of Cialis (tadalafil) within the previous 48 hours
Hypotension or uncorrected hypovolemia
Severe anemia
Restrictive pericarditis or pericardial tamponade
Documented right sided acute myocardial infarction

Adult dosages

EMR: Relief from chest pain suggestive of acute coronary syndrome

Requires CliniCall consultation if the patient has no prior prescription for nitroglycerin, or if more than 3 doses are needed
0.4 mg SL every 3-5 minutes
- Verify systolic blood pressure prior to administering each dose. Systolic blood pressure must be > 110 mmHg.

ACP: Reduction of blood pressure in acute cardiogenic pulmonary edema

0.4 mg SL every 3-5 minutes

CCP: All indications

10-200 mcg/min IV infusion

Pediatric Considerations And Dosing

Not authorized

Mechanism Of Action

Relaxes smooth muscle in vasculature. Nitroglycerin works primarily as a venodilator, but can also produce coronary and systemic arterial vasodilation, decreasing preload and lowering myocardial oxygen consumption.

Pharmocokinetics

Sublingual

Onset: 1-3 minutes
Peak: uncertain
Half-life: 1-4 minutes
Duration: 30 minutes

Adverse Effects

Hypotension
Headache
Nausea

Warning And Precautions

Do not administer to patients whose blood pressure is < 110 mmHg, or who are exhibiting signs of significant hypoperfusion.

Use with caution in patients with hepatic or renal insufficiency.

Exercise caution (and rule out right-sided involvement) in patients with documented inferior ischemia on 12-lead ECG.

Drug Interactions

Antihypertensive agents may act synergistically with nitroglycerin.