Nitroglycerin
NITROSTAT
Pronunciation: nye-troe-GLI-ser-in (NYE-troe-stat)
“Knight glistenin’”
gummy theme of the osmotic diuretic glycerin (although NTG is made from glycerol)
What it isNitric oxide donor causing venodilation; acute angina and heart failure.
Why this oneSublingual onset within minutes makes it the rescue agent for angina.
What limits itTolerance develops with continuous exposure, so a nitrate-free interval is needed. Fatal hypotension with PDE5 inhibitors; avoid in aortic stenosis and right ventricular infarction.
FDA-approved for
- angina (~1938)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute anginal attack (relief) | Adults | 1 tab SL PRN at onset | may repeat 1 tab q5min PRN | 3 tabs / 15 min |
| Angina prophylaxis | Adults | 1 tab SL 5-10 min before precipitating activity | 1 tab SL PRN | 3 tabs / 15 min |
Renal Undefined
Hepatic Undefined
No more than 3 tablets within 15 min; may repeat every 5 min
Instructions
- Place under the tongue or in the buccal pouch; allow to dissolve without swallowing
- Administer at rest, preferably sitting
- For xerostomia, a small sip of water before dosing may aid dissolution
Available strengths
- SL tab 0.3, 0.4, 0.6 mg
- cap 2.5, 6.5, 9 mg
- inhaler 400 mcg/spray
- ointment 0.4, 2 %
- patch 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hr
- spray 400 mcg/spray
- inj 5, 10 mg/mL
Contraindications
- Concomitant PDE-5 inhibitors (avanafil, sildenafil, tadalafil, vardenafil) — severe hypotension
- Concomitant soluble guanylate cyclase stimulators (e.g., riociguat)
- Severe anemia
- Increased intracranial pressure (e.g., cerebral hemorrhage, traumatic brain injury)
- Circulatory failure and shock
Cautions
- Tolerance with excessive use — use smallest effective dose
- Severe hypotension (esp. upright, volume-depleted, constrictive pericarditis, aortic/mitral stenosis); may cause paradoxical bradycardia
- May aggravate angina of hypertrophic obstructive cardiomyopathy
- Dose-related headache
Adverse reactions
- Headache
- Dizziness
- Paresthesia
- Postural hypotension (weakness, palpitation)
- Syncope
Pregnancy Limited data insufficient to determine risk; no adverse developmental effects in animals at >64x human dose
Lactation Not studied in lactating women; unknown if present in human milk
Cost
Generic entry1985
NO BOXED WARNINGS
Principal riskHypotension; fatal with PDE5 inhibitors
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
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