NITROGLYCERINE/GLYCERYL TRINITRATE

Indications & Dose:

Prophylaxis and treatment of angina

• BY SUBLINGUAL ADMINISTRATION USING SUBLINGUAL TABLETS

Adult: 0.3–1 mg, dose may be repeated as required

Control of hypertension and myocardial ischaemia during and after cardiac surgery Induction of controlled hypotension during surgery

Congestive heart failure

Unstable angina

• BY INTRAVENOUS INFUSION

Adult: 10–200 micrograms/minute (max. per dose 400 micrograms/minute), adjusted according to response,  consult  product  literature  for recommended starting doses specific to indication

Treatment or prophylaxis of angina

• BY SUBLINGUAL ADMINISTRATION USING AEROSOL SPRAY

Adult: 1–2 sprays, dose be administered under tongue and then close mouth

Anal fissure

• BY RECTUM USING OINTMENT

Adult: Apply 2.5 centimetres every 12 hours until pain stops. Max. duration of use 8 weeks, apply to anal canal, 2.5 cm of ointment contains 1.5mg of glyceryl trinitrate

PATCH

Prophylaxis of angina

• BY TRANSDERMAL APPLICATION

Adult: One ‘5’ or one ‘10’ patch to be applied to lateral chest wall, upper arm, thigh, abdomen, or shoulder; increase to two ‘10’ patches every 24 hours if necessary, to be replaced every 24 hours,siting replacement patch on different area

ORAL: BUCCAL: Adults: Initial 1 mg every 3-5 hours while awake (3 times day); titrate dosage upward if angina occurs with tablet in place.

Contraindications:

Severe anemia,closed-angle glaucoma, postural hypotension, early MI (SL), head trauma, cerebral hemorrhage,hypotension or  uncorrected hypovolemia,inadequate cerebral circulation,  increased intracranial pressure, constrictive pericarditis, pericardial tamponade (IV)

Side Effects:

CNS: Agitation, anxiety, apprehension, confusion, dizziness, dyscoordination, headache, hypoesthesia, hypokinesia, insomnia, nervousness, nightmares, restlessness, vertigo, weakness

CV: Atrial fibrillation, collapse, crescendo angina, dysrhythmias, palpitations, postural hypotension, premature ventricular contractions, rebound hypertension, retrosternal discomfort, syncope, tachycardia

EENT: Blurred vision

GI: Abdominal pain, diarrhea, dyspepsia, fecal incontinence, nausea, tenesmus, tooth disorder, vomiting

GU: Dysuria, impotence, urinary frequency

HEME: Hemolytic anemia, methemoglobinemia

MS: Arthralgia

SKIN: Allergic reactions (ointment), contact dermatitis (transdermal), crusty skin lesions, cutaneous vasodilation with flushing, exfoliative dermatitis, pallor, pruritus, rash, sweating

Cautions:

Precautions:

Early days of MI. Hypertrophic cardiomyopathy: severe hepatic, renal disease: children, glaucoma, abrupt withdrawal. Continuous delivery (tolerance develops rapidly. IV excepted)

PREGNANCY, BREAST-FEEDING & OLD AGE:Use with caution.

Interaction:

Drugs

 Ergot alkaloids: Opposition to coronary vasodilatory effects of nitrates

Ethanol: Additive vasodilation could cause hypotension

Metronidazole: Ethanol contained in IV nitroglycerine preparations could cause disulfiram-like reaction in some patients

Sildenafil: Excessive hypotensive effects 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: