Nitroglycerin
GENERIC NAME
Nitroglycerin
TRADE NAME
Nitrostat
DESCRIPTION
Nitroglycerin is a potent smooth muscle relaxant used primarily in the treatment of angina pectoris. It causes vasodilation, reducing cardiac workload and increasing coronary blood flow.
HOW SUPPLIED
Tablet or spray: 0.4 mg per tablet or spray
INDICATIONS
- Chest pain indicative of acute coronary syndrome (ACS)
CONTRAINDICATIONS
- Allergy or hypersensitivity to Nitroglycerin
- Systolic blood pressure less than 120 mmHg if no 12-lead ECG has been obtained
- Systolic blood pressure less than 90 mmHg with a 12-lead ECG, and no signs of inferior MI
- Inferior MI indicated on 12-lead ECG (no nitrates should be given)
- Patient has taken erectile dysfunction medication (Sildenafil/Viagra, Tadalafil/Cialis, Vardenafil/Levitra) within the past 48 hours
MECHANISM OF ACTION
Nitroglycerin relaxes smooth muscle, causing vasodilation. This results in decreased preload and reduced cardiac workload, as well as increased coronary blood flow and perfusion of the heart. Pain relief typically occurs within 1–2 minutes, and therapeutic effects last up to 30 minutes.
SIDE EFFECTS
- Headache
- Dizziness
- Weakness
- Tachycardia
- Hypotension
AUTHORIZATION
AEMT: Standing order (1 dose only)
Paramedic: Standing order
DOSAGE
| Patient Type | Route | Dosage | Frequency | Maximum Doses |
|---|---|---|---|---|
| Adult | Sublingual (SL) | 0.4 mg | Every 3–5 minutes | Up to 3 doses, or until pain is relieved or contraindication occurs |
| Pediatric | Not given | N/A | ||
Administration Notes:
- Ensure blood pressure is monitored closely before and after each dose due to the risk of hypotension.
- If patient experiences significant hypotension, dizziness, or syncope, discontinue administration and reassess.
- Use with caution in patients who may have taken erectile dysfunction medications within the past 48 hours due to potential severe hypotension.