Nitroglycerin IV

Nitroglycerin IV is a prescription medication used to treat the symptoms of Chest Pain (Angina).

• Nitroglycerin IV is available under the following different brand names: Glyceryl trinitrate IV, IV Nitroglycerin, NitroBid IV, NTG, Tridil

Adult dosage

Infusion solution

• 25mg/250mL
• 50mg/250mL
• 100mg/250mL

Injectable solution

• 5mg/mL

Angina

Adult dosage

• 5 mcg/min
• Increase by 5 mcg/min every 3-5 min up to 20 mcg/min, then increase by 10 mcg/min. 
• May increase by 20 mcg/min

Dosage Considerations – Should be Given as Follows: 

• See "Dosages,"

Common side effects of Nitroglycerin IV include:

• flushing (sudden warmth, redness, or tingly feeling), 
• lightheadedness, 
• fainting, 
• headache, 
• dizziness, 
• numbness, 
• tingling, and 
• burning pain

Serious side effects of Nitroglycerin IV include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• sweating, 
• pale skin, 
• nausea, 
• vomiting, 
• weakness, 
• lightheadedness, 
• severe or throbbing headaches that do not become less severe with continued use of nitroglycerin, 
• pounding heartbeats, 
• fluttering in the chest, 
• slow heart rate, 
• blurred vision, 
• dry mouth, 
• chest pain or pressure, 
• pain spreading to the jaw or shoulder, 
• nausea, and
• sweating

Rare side effects of Nitroglycerin IV include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first

• Nitroglycerin IV has severe interactions with at least 12 other drugs.
• Nitroglycerin IV has serious interactions with the following drugs: 
  • cabergoline
  • ergoloid mesylates
  • ergotamine
  • lofexidine 
  • methylergonovine
• Nitroglycerin IV has moderate interactions with the following drugs:
  • arginine
  • benazepril
  • bretylium
  • bupivacaine implant
  • dapsone topical
  • tetracaine 
• Nitroglycerin IV has minor interactions with the following drugs: 
  • acetylcysteine
  • acetylcysteine (antidote)
  • ethanol
  • heparin
  • metronidazole 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life
• Riociguat; coadministration may cause hypotension
• Narrow angle glaucoma (controversial: may not be clinically significant)
• Hypersensitivity
• Symptomatic hypotension, uncorrected hypovolemia, increased intracranial pressure (head trauma, cerebral hemorrhage), severe anemia, constrictive pericarditis, pericardial tamponade, restrictive cardiomyopathy

Effects of drug abuse

• None

Short-Term Effects

• See “What are Side Effects Associated with Using Nitroglycerin IV?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Nitroglycerin IV?”

Cautions

• Use caution in alcohol use, hyperthyroidism, hypertrophic cardiomyopathy, postural hypotension, severe renal impairment, hepatic impairment
• Gradually decrease dose to avoid withdrawal reaction
• May need 10-12 hr/day nitrate-free interval to avoid tolerance development
• Doses ~ 200 mcg/min
• Some products contain alcohol and propylene glycol
• Remove topical forms when starting IV infusion
• Use glass bottles and non-PVC (polyvinyl chloride) tubing to avoid adsorption of drug to delivery devices; use of PVC tubing in infusion sets may lead to loss of active ingredient due to adsorption of nitroglycerin to PVC tubing; dosage is affected; adsorption by PVC tubing is increased when tubing is long, flow rates are low, and nitroglycerin concentration of solution is high; delivered fraction of solution's original nitroglycerin content has been 20-60% in published studies; fraction varies with time during single infusion, and no simple correction factor can be used; if intravenous nitroglycerin is administered through non-adsorptive tubing, doses based upon published reports will generally be too high; some in-line intravenous filters also adsorb nitroglycerin and should be avoided
• Solutions containing dextrose without electrolytes should not be administered through the same administration set as blood, as this may result in pseudo agglutination or hemolysis
• Intravenous administration of solutions may cause fluid overloading resulting in dilution of serum electrolyte concentrations, overhydration and congested states of pulmonary edema; risk of dilutional states is inversely proportional to electrolyte concentrations of injections; risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to electrolyte concentration of injections
• Severe hypotension and shock may occur with even small doses of nitroglycerin; monitor patients who may be volume depleted or, for whatever reason, are already hypotensive; hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris
• Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy
• Tolerance development and occurrence of cross tolerance to other nitro compounds reported
• Administer nitroglycerin in 5% dextrose Injection only via infusion pump that can maintain constant infusion rate
• Monitor patients with known sub-clinical or overt diabetes mellitus when using solutions containing dextrose
• Cases of methemoglobinemia reported with moderate doses of organic nitrates; when methemoglobinemia is diagnosed, discontinue treatment of nitroglycerin; if condition not reversed, treat with methylene blue, 1-2 mg/kg intravenously
• Protect from freezing and light
• Do not change brands unintentionally as not all are bioequivalent
• Treat drug-induced headache with aspirin or acetaminophen
• Provide nitrate-free interval (10-12 hr or overnight) to avoid development of tolerance
• Use supportive treatment in overdose; there is no specific antidote for overdose; risk of overdose can be minimized by close monitoring during treatment
• Drug interaction overview
  • The vasodilating effects of nitroglycerin may be additive with those of other antihypertensives. (e.g., beta-blockers, calcium channel blockers and tricyclic antidepressants) and may cause increased hypotensive effects
  • Concomitant use of nitroglycerin in 5% dextrose injection concomitant use with phosphodiesterase inhibitors (e.g. sildenafil, tadalafil, or vardenafil) in any form is contraindicated
  • Concomitant use of nitroglycerin in 5% dextrose injection with riociguat, a soluble guanylate cyclase stimulator, can cause hypotension and is contraindicated
  • Marked symptomatic orthostatic hypotension reported when calcium channel blockers and organic nitrates used in combination
  • Nitroglycerin at higher dosages may interfere with anticoagulant effect of heparin; intravenous nitroglycerin can induce heparin resistance

Pregnancy and Lactation

• Used with caution during pregnancy if benefits out weight risks. 
• Lactation: developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for nitroglycerin and any potential adverse effects on breastfed child from nitroglycerin or from underlying material condition.