Short Acting Nitroglycerin

Aka: Short Acting Nitroglycerin, Short Acting Nitrates, Sublingual Nitroglycerin, Nitroglycerin Spray, Nitroglycerin Powder, Glyceryl trinitrate spray, Nitrostat, Nitrolingual Pumpspray, NitroMist, GoNitro

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II. Indications

  1. Acute Myocardial Ischemia (Angina Pectoris)
    1. Exertional or rest Angina

III. Precautions

  1. Do not take more than 3 Nitroglycerin doses in 15 minutes
  2. Seek immediate attention (call 911):
    1. Anginal pain not improved after the first Nitroglycerin after 5 minutes

IV. Preparations

  1. Nitroglycerin Sublingual (0.15 to 0.6 mg)
    1. Sublingual 0.4 mg prn Angina up to 3 in 15 minutes
    2. One tablet may be used preventively before activity expected to cause Angina
    3. Costs roughly 40 cents per tablet
    4. Sublingual tablets are now good until expiration bottle (even after opening)
      1. Formulation lasts 2 years from manufacture date
      2. Assumes the bottle is kept capped, at room Temperature
      3. Older formulations in the distant past needed replacement every 6 months
  2. Nitroglycerin Spray (0.4 mg/spray)
    1. Spray 1 to 2 under Tongue prn Angina up to 3 sprays in 15 minutes
    2. One spray may be used preventively before activity expected to cause Angina
    3. Prime spray before use (number of prime sprays vary 1, 5 ot 10 by device) and again every 6 weeks if not used
    4. Expensive ($1.50 to $4.50 per spray in 2016)
  3. Nitroglycerin Powder (single dose packet)
    1. Open packet and pour under Tongue up to 3 in 15 minutes
    2. Expensive ($7 per packet in 2016)

V. Adverse Effects

  1. See Nitroglycerin

VI. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

VII. Mechanism

  1. See Nitroglycerin

VIII. Resources

  1. Nitroglycerin Sublingual Tablets (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=79ba021e-183c-4b4d-822e-4ff5ef54ca61
  2. Nitroglycerin Spray (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3214ddac-e068-4306-8500-0fa90c8c5842

IX. References

  1. (2016) Presc Lett 23(11)
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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