Nitroglycerin

Aliases: Nitrostat 

Indications: Chest Pain, CHF/Pulmonary Edema      

Contraindications: Hypotension, hypovolemia, severe bradycardia, or tachycardia, use of erectile dysfunction drugs within past 24hrs up to 48 hours depending on use of extended-release medications. 

Concentrations: 

Sublingual Spray/Tablet: 400mcg (0.4mg)/dose

Injection/Infusion: 100-400 mcg/mL

Dosing

Adult:

Indication Dose Route Note 
Chest Pain – ACS suspected0.4 mgSublingualRepeat every 5 mins PRN. Maintain SBP > 100 mmHg 
Chest Pain – ACS suspected5-50 mcg/min Infusion For refractory chest pain or STEMI/ACO only. 
Titrate to pain relief or SBP > 100 mmHg. 
Pulmonary Edema from Acute Heart Failure (Hypertensive Crisis)1st dose: 1000 mcg Slow IV Push After NIPPV, consider IV Push before infusion. 
Goal SBP 140-160 mmHg. Titrate infusion PRN.
Pulmonary Edema from Acute Heart Failure (Hypertensive Crisis)2nd dose: 200 to 400 mcg/min Infusion After NIPPV, consider IV Push before infusion. 
Goal SBP 140-160 mmHg. Titrate infusion PRN.

Pediatric:

Indication Dose Route Note 
NONE
Use Handtevy or Approved Pediatric Reference Guide for Amount to Administer

Precautions: Headache, Tachycardia 

Adverse/Side Effects: Hypotension, Syncope  

Class: Nitrate    

Mechanism of Action: Potent vasodilator with antianginal, anti-ischemic, and antihypertensive effects. Relaxes vascular smooth muscle by an unknown mechanism. Decreases peripheral vascular resistance, preload, and afterload. 

Onset of ActionPeak EffectDuration of Action 
SL: 1-3 minutes 
IV: Immediate 		5 minutes Less than 10 minutes