1 vial 50mg in 50ml

$8.86

1 patch 5mg/24 hours

80 cents

GTN, Nitronal, Lycinate, Glytrin, Nitrolingual, Minitran, Nitroderm

  • Afterload reduction / peripheral vasodilation

  • Treatment of hypertension

  • Treatment of angina

IV:
Nitronal 50ml contains 50mg of GTN in 50ml of 5% dextrose
Use undiluted

GTN is readily absorbed into many plastics. Original Perfusor PE tubing causes minimal absorption and is preferred. If other plastics are used, GTN may be absorbed by the tubing particular when running at low rates.

IT SHOULD BE NOTED THAT WHEN THE APPROPRIATE INFUSION SETS ARE USED, THE CALCULATED DOSE WILL BE DELIVERED TO THE PATIENT BECAUSE THE LOSS OF NITROGLYCERIN DUE TO ABSORPTION IN STANDARD PVC TUBING WILL BE KEPT TO A MINIMUM. NOTE THAT THE DOSAGES COMMONLY USED IN PUBLISHED STUDIES UTILIsED GENERAL-USE PVC INFUSION SETS, AND RECOMMENDED DOSES BASED ON THIS EXPERIENCE ARE TOO HIGH IF THE LOW ABSORBING INFUSION SETS ARE USED.

Compatible with the following IV fluids:
5% dextrose Normal saline Glucose and sodium chloride
Do not mix with other medications
Store at room temperature and protect for light

Transdermal:
Apply once daily to chest or upper arm for 12-18 hours (brand dependent) followed by a 6-12 hour nitrate-free period (usually overnight)
Minitran 5mg/24 hours and 10mg/24 hours
Nitroderm TTS 5mg/24 hours (25mg) and 10mg/24 hours (50mg)
Sublingual tablets:
Lycinate 600mcg tablets
Sublingual spray:
Glytrin spray 400mcg/dose
Nitrolingual pump spray 400mcg/dose


ADULT DOSE

IV infusion:
IV infusion dose range is 0-12ml/hr (equivalent to 0-200mcg/min). In ICU it is usually appropriate to commence the infusion at 5ml/hr and to titrate to effect.

Transdermal:
Usually commence with 5mg/24 hours patch; maximum two 10mg/24 hours patches


Sublingual tablets:

1 tablet under the tongue every 3-5 minutes as required

PAEDIATRIC DOSE

IV infusion:
<30kg 3mg/kg in 50ml 5% dextrose at 0.5-5ml/hr (0.5-5mcg/kg/min)
>30kg 3mg/kg in100ml 5% dextrose at 1-10ml/hr (0.5-5mcg/kg/min)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose as in normal renal function

The principal pharmacologic action of nitroglycerin is relaxation of vascular smooth muscle, producing a vasodilator effect on both peripheral arteries and veins with more prominent effects on the latter. Dilation of the postcapillary vessels, including large veins, promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure (preload). Arteriolar relaxation reduces systemic vascular resistance and arterial pressure (afterload).

CONTRAINDICATIONS:

  • Known hypersensitivity to glyceryl trinitrate


WARNINGS
Occasionally, high dose GTN may lead to worsened oxygenation due to increased shunting

PRECAUTIONS
General
GTN may lead to severe hypotension in patients with haemodynamically significant aortic stenosis.
Laboratory Tests
No tests in addition to routine ICU tests are required
Drug/Laboratory Test Interactions
None of note

Amplification of the vasodilatory effects of nitroglycerin by sildenafil can result in severe hypotension.
Additive effects may be observed when GTN is combined with other antihypertensives

Body as a Whole:
Allergic reactions
Cardiovascular System:
Tachycardia, hypotension, syncope, rebound hypertension, palpitations
Gastrointestinal System;
Nausea, vomiting, abdominal pain
Central Nervous System:
Headache
Haematological System:
Methaemoglobinaemia

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