Nitroglycerin (Sublingual Spray)
Generic Details
Generic Name
Nitroglycerin Sublingual Spray
Other Names
- Nitrostat
- Nitrolingual
Drug Class
- Nitrate
Chemical Formula
C3H5N3O9
Molecular Weight
227.087 g/mol
Mechanism of Action
- Nitroglycerin is a vasodilator that works by relaxing smooth muscle in blood vessels, dilating coronary arteries, and improving blood flow to the heart.
Indications
- Angina pectoris
- Acute relief of angina attacks
- Prophylaxis of angina before activities known to trigger an attack
Common Dosage Forms
- Sublingual spray
Typical Dosage
- 0.4 mg - 0.8 mg under the tongue at the onset of chest pain. May repeat every 5 minutes for a maximum of 3 doses.
Pediatric Dosage
- Safety and efficacy not established in children
Geriatric Dosage
- Dose adjustment may be needed due to potential age-related changes in hepatic, renal, and cardiovascular function
Side Effects
- Headache
- Hypotension
- Flushing
- Dizziness
- Tachycardia
- Nausea
- Vomiting
Contraindications
- Hypersensitivity to nitroglycerin
- Use of phosphodiesterase-5 inhibitors (e.g., Sildenafil, Tadalafil)
Pregnancy Category
- Category C - Risk can't be ruled out
Lactation Safety
- Use caution, excretion in breast milk unknown
Drug Interactions
- Hypotensive effects may be enhanced when used with other vasodilators or antihypertensive agents
Overdose Symptoms
- Severe hypotension
- Cyanide toxicity
Antidote for Overdose
- Methylene blue
- Sodium nitrite
Storage Conditions
- Store at room temperature away from light and moisture
Pharmacokinetics
- Absorption: Rapidly absorbed through the oral mucosa
- Distribution: Widely distributed, including into saliva and breast milk
- Metabolism: Primarily hepatic via denitration
- Excretion: Renally as metabolites
Precautions
- Use caution in patients with hypotension, intracranial pressure, or those prone to increased intracranial pressure
- Avoid abrupt withdrawal to prevent rebound angina
Warnings
- May cause severe hypotension
- Tolerance may develop with prolonged use
- Avoid use with moderate or strong CYP3A4 inhibitors
Others
- It is important to keep nitroglycerin tablets or spray with you at all times and to replace them before they expire.