Organic nitrate
ATC code: C01DA02 (Glyceryl trinitrate)
Brand names
Nitrostat, Nitro-Bid, Nitro-Dur, Nitrolingual, Nitromist
Releases nitric oxide that relaxes vascular smooth muscle. Decreases pre- and afterload, dilates coronary arteries. Used for angina attacks and acute heart failure. Absolutely contraindicated with PDE-5 inhibitors (sildenafil, etc.) due to severe hypotension.
First line
Sublingual or intravenous nitroglycerin is used in acute coronary syndrome to reduce myocardial ischemia, control hypertension, and relieve pulmonary congestion. Intravenous infusion (start at 5–10 mcg/min, titrate to BP and pain) is indicated for ongoing ischemia, hypertension, or heart failure. Avoided in systolic BP below 90 mm Hg, right-ventricular infarction, and after recent phosphodiesterase-5 inhibitor use.
Second line
In acute decompensated heart failure with pulmonary congestion and preserved arterial perfusion, intravenous nitroglycerin lowers preload, reduces dyspnea, and unloads the left ventricle. 2023 recommends use in patients with systolic BP above 110 mm Hg. Start infusion at 10–20 mcg/min with titration by BP and symptoms. Avoided in cardiogenic shock and systolic BP below 90 mm Hg.
First line
Sublingual nitroglycerin 0.3–0.6 mg or spray is the drug of choice for terminating a stable angina episode. Onset is 1–3 minutes, duration 20–30 minutes. / 2023 and 2024 recommend that every patient with stable CAD carry a sublingual formulation. If pain persists 5 minutes after the first dose, call emergency services – the picture may represent acute coronary syndrome. Prophylactic use 5–10 minutes before anticipated exertion is acceptable.
Sources
First line
Long-acting nitrates (nitroglycerin ointment, patch, sustained-release tablets, or isosorbide mono/dinitrate) prevent attacks in Prinzmetal vasospastic angina. 2023 recommends combined calcium channel blockers and long-acting nitrates as baseline therapy. A 8–12-hour nitrate-free interval is preserved between doses to prevent tolerance.
1 pair found. Sorted from critical to minor.
Mechanism
Синергическая активация cGMP-зависимой релаксации сосудов. Тяжелая гипотензия, описаны летальные исходы.
Management
Абсолютное противопоказание. После приема силденафила нитраты только через 24 часа, тадалафила – через 48 часов.
nitroglycerin is evaluated for the following indications with varying evidence strength: Stable angina pectoris (evidence tier A), Acute coronary syndrome (evidence tier A), Heart failure with reduced ejection fraction (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of nitroglycerin (≥ 1 in 100): Headache (throbbing, resolves in 20–30 minutes or after several doses), Facial flushing, sensation of warmth, Hypotension, orthostatic reactions, Reflex tachycardia, Dizziness. See the Safety section for uncommon and serious reactions.
FDA category C. FDA category C. In pregnancy, nitroglycerin is used for acute coronary syndrome, acute pulmonary edema, hypertensive emergencies with pulmonary edema, and acute tocolysis in uterine hyperstimulation. Decision is made by a specialized team.
Data on nitroglycerin transfer into human milk are limited. A single sublingual dose is considered compatible with breastfeeding. With long-term nitrate therapy, alternatives are considered.
nitroglycerin is contraindicated in: Systolic BP below 90 mm Hg; PDE5 inhibitors within 24 hours (sildenafil, vardenafil) or 48 hours (tadalafil); Riociguat (a guanylate cyclase stimulator); Right-ventricular myocardial infarction; Cardiogenic shock and severe hypovolemia. Full list in the Safety section.
FDA category C. In pregnancy, nitroglycerin is used for acute coronary syndrome, acute pulmonary edema, hypertensive emergencies with pulmonary edema, and acute tocolysis in uterine hyperstimulation. Decision is made by a specialized team.
Data on nitroglycerin transfer into human milk are limited. A single sublingual dose is considered compatible with breastfeeding. With long-term nitrate therapy, alternatives are considered.
sublingual formulations do not cause addiction – they are used episodically. Tolerance is a pharmacological phenomenon of continuous exposure (24-hour patch, sustained-release without breaks), not situational use.
throbbing headache is an expected adverse effect of peripheral vasodilation. It resolves in 20–30 minutes or after several uses with partial tolerance to this effect.
if pain persists 5 minutes after the first dose, call emergency services. This may be acute coronary syndrome requiring thrombolysis or PCI, not more nitrate.