Also known as glyceryl trinitrate (GTN)
In the nitrate family of medications
Works by relaxation of smooth muscle, producing a vasodilator effect on the peripheral veins and arteries
primarily reduces cardiac oxygen demand by decreasing preload (left ventricular end-diastolic pressure); may moderately decrease afterload; dilates coronary arteries and improves collateral flow to ischemic regions
Concentration: 100 mg/ 250 mL D5W (pre-mixed solution, in glass bottle)
Starting Dose Range: 5 mcg/min
Titration Dose Increment: Â 5 mcg/min *
Rate of Titration: 3-5 minutes
Maximum Dose: 200 mcg/min
Maximum Peripheral Dose: n/a
Central/ Peripheral: either
*= if no response is observed at 20 mcg/min, increase dose by 10-20 mcg/min every 3- 5 minutes
Once partial response is observed, the rate of dose increases should be reduced and intervals between increases should be lengthened
Indications include:
control of blood pressure and hypertension
treatment of congestive heart failure associated with acute myocardial infarction
treatment of angina pectoris unresponsive to conventional therapy
treatment of hypertensive urgencies (as a second line option to labetalol)
Contraindications include:
hypersensitivity or known idiosyncratic reaction to nitrates
hypotension or uncorrected hypovolemia
constrictive pericarditis or pericardial tamponade
increased intracranial pressure
current or recent use of a phosphodiesterase-5-inhibitor (sildenafil, tadalafil, vardenafil)
Adverse Effects
Cardiovascular- hypotension, reflex tachycardia
CNS- headache, dizziness
Metabolic- methemoglobinemia
Excessive and prolonged dosing may produce adverse effects such as alcohol intoxication and propylene glycol (Alcohol and propylene glycol are solvents in the formulation)