Generic
Nitroglycerin (IV Infusion)
2 brands available in the market
At a glance
Nitroglycerin (IV Infusion) is a vasodilator used for peri-operative hypertension, congestive heart failure in acute MI, angina not responding to sublingual nitroglycerin and beta-blockers, and induction of intraoperative hypotension.
Description
The principal pharmacological action of nitroglycerin is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins. Dilation of veins promotes peripheral pooling of blood and decreases venous return, reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic and mean arterial pressure (afterload). Dilation of coronary arteries also occurs.
Indications
- Peri-operative hypertension
- Controlling congestive heart failure in acute myocardial infarction
- Angina pectoris not responding to sublingual nitroglycerin and beta blockers
- Induction of intraoperative hypotension
Therapeutic class
Nitrates: Coronary Vasodilators
Pharmacological class
Organic Nitrate
Pharmacology
Nitroglycerin forms nitric oxide (NO) which activates guanylate cyclase, increasing cyclic GMP in smooth muscle, leading to dephosphorylation of myosin light chains and vasodilation.
Mechanism of action
Dilates blood vessels to reduce heart workload and control blood pressure.
Dosage
Initial Dilution:
- Transfer 50 mg nitroglycerin into 500 mL Dextrose (5%) or Sodium Chloride (0.9%) → 100 mcg/mL concentration
Maintenance Dilution:
- Concentration may be increased to max 400 mcg/mL if needed
- Not for direct IV injection
Administration
- IV infusion only
- Dilute in Dextrose (5%) or Sodium Chloride (0.9%)
- Do not mix with other drugs
Missed dose
Not generally applicable (scheduled administration); consult doctor if needed.
Side effects
Common Side Effects:
- Headache (may be severe)
- Lightheadedness (related to blood pressure changes)
- Hypotension
- Syncope
- Crescendo angina
- Rebound hypertension
- Methemoglobinemia (extremely rare)
Precautions & warnings
- Severe hypotension and shock may occur with even small doses
- Hypotension may be accompanied by paradoxical bradycardia and increased angina
- May aggravate angina in hypertrophic cardiomyopathy
- Physical dependence may develop in industrial workers
Contraindications
- Allergy
- Pericardial tamponade
- Restrictive cardiomyopathy
- Constrictive pericarditis
Drug interactions
- Additive effects with other vasodilators
- Pseudoagglutination and hemolysis if infused with blood
- Interferes with anticoagulant effect of heparin
Food interactions
No food interactions (IV administration).
Use in pregnancy
Use in Pregnancy: Nitroglycerin may be unsafe during pregnancy (Category C); use only if clearly needed.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Unknown if excreted in human milk; use with caution.
Pediatric use
Safety and effectiveness not established in children.
Geriatric use
Elderly may require dose adjustment.
Renal / hepatic impairment
Renal Impairment: Caution in kidney disease; dose adjustment may be needed.
Hepatic Impairment: Caution in liver disease; dose adjustment may be needed.
Overdose effects
Overdose: Vasodilation, venous pooling, reduced cardiac output, hypotension, increased intracranial pressure, headache, confusion, fever, vertigo, palpitation, visual disturbances, nausea, vomiting, syncope, dyspnea, bradycardia, paralysis, coma, seizures, death.
Storage conditions
Store below 30°C; protect from light & moisture; keep out of reach of children.
Chemical structure
Nitroglycerin IV Infusion