Nitroglycerin

Aka: Nitroglycerin, Antianginal

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II. History

  1. Albert Nobel stabilized Nitroglycerin for dynamite
    1. Some postulate that he died of Nitroglycerin toxicity

III. Preparations

  1. Short Acting Nitroglycerin
  2. Long Acting Nitroglycerin
  3. Intravenous Nitroglycerin

IV. Indications

  1. Angina Pectoris
  2. Acute Myocardial Infarction
  3. Left Ventricular Failure (Congestive Heart Failure)

V. Contraindications

  1. Aortic Stenosis
  2. Pulmonary Hypertension
  3. Hypotension
  4. Phosphodiesterase Inhibitor (e.g. Viagra)
  5. Right sided Myocardial Infarction (seen with inferior Myocardial Infarction)

VI. Mechanism

  1. Relaxes vascular Smooth Muscle
  2. Venous Dilation (more than Nitroprusside)
    1. Inhibits venous return (Preload)
      1. Decreases intra-myocardial wall tension
      2. Decreases intraventricular work
    2. Reduces left ventricular filling pressure
      1. Decreases myocardial oxygen demand
      2. Reduces Myocardial Ischemia
    3. Cardiac Output
      1. Increased in Congestive Heart Failure
      2. Decreased or normal if no Heart Failure
  3. Arterial Dilation (less than Nitroprusside)
    1. Relieves Angina
    2. Dilates large coronary arteries
    3. Antagonizes vasospasm
    4. Increases coronary collateral Blood Flow
      1. Increases perfusion to ischemic Myocardium
    5. Decreases Systemic Vascular Resistance
  4. Esophageal Spasm also responds to nitrates
    1. Pain relief with Nitroglycerin is not always Angina

VII. Drug Interactions

  1. Phosphodiesterase Inhibitors (e.g. Viagra or Sildenafil)
    1. Profound hypotensive reaction
    2. Do not use with Nitroglycerin!
    3. Nitrates may be used >24 hours after Sildenafil or vardenafil or >48 hours after Tadalafil
  2. Tissue Plasminogen Activator (Alteplase, tPA)
    1. IV Nitroglycerin may reduce plasma concentrations
  3. Heparin
    1. IV Nitroglycerin may reduce Anticoagulant response

VIII. Adverse Effects

  1. Headache
  2. Hypotension
    1. High risk with Aortic Stenosis, Pulmonary Hypertension, Hypotension, PDE5 Inhibitor, right-sided Myocardial Infarction
    2. Reduce Nitrate dose
    3. Administer Intravenous Fluid bolus
    4. Consider Atropine if Bradycardia present
  3. Methemoglobinemia
  4. Hypoxemia (Ventilation-perfusion mismatch)

IX. References

  1. Orman and Mattu in Herbert (2017) EM:Rap 17(7): 6-7

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Related Studies

Cost: Medications

nitroglycerin (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
NITROGLYCERIN 0.1 MG/HR PATCH Generic $0.66 each
NITROGLYCERIN 0.2 MG/HR PATCH Generic $0.47 each
NITROGLYCERIN 0.3 MG TABLET SL Generic $0.30 each
NITROGLYCERIN 0.4 MG TABLET SL Generic $0.57 each
NITROGLYCERIN 0.4 MG/HR PATCH Generic $0.54 each
NITROGLYCERIN 0.6 MG/HR PATCH Generic $0.79 each
NITROGLYCERIN 400 MCG SPRAY Generic $42.93 per gram
NITROGLYCERIN ER 2.5 MG CAP Generic $0.27 each
NITROGLYCERIN ER 6.5 MG CAP Generic $0.37 each
NITROGLYCERIN LINGUAL 0.4 MG Generic $34.50 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Related Topics in Pharmacology

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