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Nitroglycerin Drip

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Nitroglycerin Drip, Intravenous Nitroglycerin, Nitroglycerin Infusion

  • Indications
  1. Acute Myocardial Ischemia (Angina Pectoris)
  2. Acute Myocardial Infarction
    1. Limits infarct expansion
    2. Reduces infarct size
      1. Inferior wall Myocardial Infarction
      2. Congestive Heart Failure associated with infarction
    3. Decreases vasospasm at site of Plaque rupture
  3. Congestive Heart Failure with Acute Pulmonary Edema
  4. Hypertensive Emergency
    1. Specifically indicated for Hypertensive Emergency with Acute Pulmonary Edema
    2. Nicardipine (or Esmolol) are indicated as first line agents in most other cases of Hypertensive Emergency
  • Contraindications
  1. See Nitroglycerin
  • Preparation
  1. Mix 50 mg Nitroglycerin in 250 ml D5W (200 mcg/ml)
  • Pharmacokinetics
  1. Onset in 2 minutes
  2. Duration 3 to 5 minutes
  3. Expect Blood Pressure to drop within 3 to 5 minutes of infusion start
  4. Effects wane within 3 to 5 minutes of stopping infusion
  5. Nitroglycerin is absorbed by polvinyl chloride (PVC) IV tubing, and therefore dosing is increased to compensate for this loss
    1. Use lower doses when non-PVC IV tubing is used
  1. Bolus: 12.5 to 25 mcg Nitroglycerin IV
    1. Consider bolus if Sublingual Nitroglycerin has not yet been given
  2. Tittration to maintenance dose
    1. Start: 10 to 20 mcg/min (3-6 ml/hour)
    2. Titrate: Increase 5 to 10 mcg/min every 5 minutes
    3. Usual dosage: 50 to 200 mcg/min (maximum 500 mcg/min)
  3. Endpoints
    1. Blood Pressure drop over 10%
    2. Adequate decrease in Systemic Vascular Resistance
    3. Adequate fall in left ventricular filling pressure
    4. Relief of Chest Pain
  1. Start
    1. Consider rapid large bolus of 400 mcg/min for 2 minutes OR
    2. Start 10 to 20 mcg/min and titrate to 100 mcg/min
  2. Next
    1. Decrease dose to 100 to 150 mcg/minute
    2. Observe for effect and be ready to decrease dose
    3. Cummulative bolus dose in Hypertensive Emergency approaches 400 mcg over 5 minutes
  • Dosing
  • Children (Not FDA Approved)
  1. Start 0.25 to 0.5 mcg/kg/min
  2. Increase by 0.5 to 1 mcg/kg/min every 3 to 5 min as needed
  3. Maximum 5 mcg/kg/min
  • Adverse Effects
  1. See Nitroglycerin
  • Mechanism
  1. See Nitroglycerin
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Adverse Effects
  1. See Nitroglycerin
  • Safety
  1. Pregnancy Category C
  2. Unknown Safety in Lactation
  • Resources
  1. Nitroglycerin Infusion (Dailymed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8c52cdf6-87be-4719-b105-f08be096d462
  • References
  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia