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.