Nitroglycerin

Nitroglycerin Brand Names

Deponit | GONITRO | Minitran | Nitrek | Nitro Bid | Nitrodisc | Nitro-Dur | Nitrogard | Nitrol | Nitrolingual | NitroMist | Nitronal | Nitroquick | Nitrostat | Nitrotab | Nitro-Time | RECTIV | Transdermal-NTG | Tridil

What is Nitroglycerin

Nitroglycerin an organic nitrate available in many dosage forms, is a vasodilator proven to be the mainstay of therapy in the management of angina pectoris.

Nitroglycerin is also used to control perioperative hypertension, to produce controlled hypotension during surgical procedures, to treat hypertensive emergencies, and to treat congestive heart failure associated with myocardial infarction.

Nitroglycerin has also been used to treat pulmonary hypertension. Synthesized in 1846, nitroglycerin was found to cause severe headaches when placed on the tongue.

The drug was later found to exhibit vasodepressor effects similar to those of the drug amyl nitrite, but with less adverse effects and better dosage control. The use of sublingual nitroglycerin for the relief of acute anginal attacks was established in 1879.

Because it is inexpensive, has a rapid onset of action, and has a well-documented efficacy, sublingual nitroglycerin is still considered the drug of choice for the acute relief of angina.

Although organic nitrates are still frequently prescribed for the relief of angina, they have recently come under scrutiny because of the controversy surrounding claims that nitrate tolerance and attenuation of pharmacodynamic effects have been demonstrated with all nitrate dosage forms.

Nitroglycerin was granted FDA approval in 1938. In June 2011, the FDA approved Rectiv, a 0.4% rectal ointment indicated for treatment of pain associated with chronic anal fissures.

Indications

1. acute myocardial infarction
2. anal fissures
3. angina
4. extravasation
5. heart failure
6. hemorrhoids
7. hypertensive emergency
8. hypotension induction
9. perioperative hypertension
10. postoperative hypertension
11. pulmonary edema
12. pulmonary hypertension
13. retained placenta
14. unstable angina

For the treatment of angina

for acute angina pectoris or for acute angina pectoris prophylaxis (i.e., situations likely to provoke an anginal attack)

Side Effects

1. abdominal pain
2. anaphylactoid reactions
3. angina
4. asthenia
5. blurred vision
6. bradycardia
7. chest pain (unspecified)
8. contact dermatitis
9. cyanosis
10. diaphoresis
11. dizziness
12. dyspnea
13. exfoliative dermatitis
14. flushing
15. headache
16. hypertension
17. hypotension
18. hypoxia
19. methemoglobinemia
20. myocardial infarction
21. nausea
22. orthostatic hypotension
23. pallor
24. palpitations
25. paresthesias
26. peripheral edema
27. peripheral vasodilation
28. pharyngitis
29. physiological dependence
30. pulmonary edema
31. rash
32. restlessness
33. rhinitis
34. sinus tachycardia
35. skin irritation
36. syncope
37. tolerance
38. vertigo
39. vomiting
40. weakness
41. xerostomia

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• abrupt discontinuation
• acute myocardial infarction
• anemia
• aortic stenosis
• breast-feeding
• cardiac tamponade
• cardiomyopathy
• constrictive pericarditis
• defibrillation (cardioversion)
• dehydration
• diabetes mellitus
• geriatric
• GI disease
• head trauma
• hepatic disease
• hypotension
• hypovolemia
• increased intracranial pressure
• intracranial bleeding
• magnetic resonance imaging (MRI)
• mitral stenosis
• nitrate hypersensitivity
• orthostatic hypotension
• pregnancy
• shock

Nitroglycerin is contraindicated in patients who have known nitrate hypersensitivity.

Interactions

• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetazolamide
• Acrivastine; Pseudoephedrine
• Alfentanil
• Alfuzosin
• Alpha-blockers
• Alprazolam
• Alteplase
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amoxapine
• Amphetamine
• Amphetamine; Dextroamphetamine
• Angiotensin II receptor antagonists
• Angiotensin-converting enzyme inhibitors
• Apomorphine
• Articaine; Epinephrine
• Aspirin, ASA
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Dipyridamole
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Aspirin, ASA; Pravastatin
• Atomoxetine
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benzocaine
• Benzocaine; Butamben; Tetracaine
• Benzodiazepines
• Benzphetamine
• Beta-adrenergic blockers
• Bosentan
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Bupropion
• Bupropion; Naltrexone
• Cabergoline
• Caffeine; Ergotamine
• Calcium-channel blockers
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Carbonic anhydrase inhibitors
• Central-acting adrenergic agents
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroprocaine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Citalopram
• Clomipramine
• Clonazepam
• Clorazepate
• Cocaine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Dapsone
• Desipramine
• Desloratadine; Pseudoephedrine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmethylphenidate
• Dextroamphetamine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Guaifenesin; Pseudoephedrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Diazoxide
• Diethylpropion
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dihydroergotamine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Phenylephrine
• Dobutamine
• Dopamine
• Doxepin
• Duloxetine
• Ephedrine
• Epinephrine
• Eplerenone
• Epoprostenol
• Ergoloid Mesylates
• Ergonovine
• Ergot alkaloids
• Ergotamine
• Escitalopram
• Estazolam
• Ethanol
• Fenoldopam
• Fentanyl
• Fexofenadine; Pseudoephedrine
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fluvoxamine
• Gallium Ga 68 Dotatate
• Glimepiride; Rosiglitazone
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guaifenesin; Pseudoephedrine
• Halothane
• Heparin
• Heterocyclic antidepressants
• Homatropine; Hydrocodone
• Hydralazine
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydralazine; Isosorbide Dinitrate, ISDN
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Iloprost
• Imipramine
• Isocarboxazid
• Isoproterenol
• Levorphanol
• Lidocaine
• Lidocaine; Prilocaine
• Lisdexamfetamine
• Loop diuretics
• Loratadine; Pseudoephedrine
• Lorazepam
• Mannitol
• Maprotiline
• Mecamylamine
• Mepenzolate
• Meperidine
• Meperidine; Promethazine
• Mepivacaine
• Mepivacaine; Levonordefrin
• Mesoridazine
• Metformin; Rosiglitazone
• Methadone
• Methamphetamine
• Methazolamide
• Methylergonovine
• Methylphenidate
• Methysergide
• Midazolam
• Midodrine
• Minoxidil
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Naproxen; Pseudoephedrine
• Nefazodone
• Nesiritide, BNP
• Nitroprusside
• Norepinephrine
• Nortriptyline
• Opiate Agonists
• Oxazepam
• Oxycodone
• Oxymorphone
• Paliperidone
• Paroxetine
• Pemoline
• Penicillin G Benzathine; Penicillin G Procaine
• Penicillin G Procaine
• Pergolide
• Perphenazine
• Perphenazine; Amitriptyline
• Phendimetrazine
• Phenelzine
• Phenothiazines
• Phentermine
• Phentermine; Topiramate
• Phenylephrine
• Phenylephrine; Promethazine
• Phosphodiesterase inhibitors
• Potassium-sparing diuretics
• Prilocaine
• Prilocaine; Epinephrine
• Procainamide
• Procaine
• Prochlorperazine
• Promethazine
• Propoxyphene
• Protriptyline
• Pseudoephedrine
• Quazepam
• Quinidine
• Racepinephrine
• Remifentanil
• Reserpine
• Riociguat
• Ritodrine
• Ropivacaine
• Rosiglitazone
• Selective serotonin reuptake inhibitors
• Sertraline
• Sincalide
• Sufentanil
• Sympathomimetics
• Temazepam
• Tetracaine
• Thiazide diuretics
• Thiethylperazine
• Thioridazine
• Tranylcypromine
• Treprostinil
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trimipramine