Glyceryl trinitrate


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult: PO Prophylaxis of angina pectoris As extended-release cap: Initial: 2.5-6.5 mg 3-4 times/day, may be increased up to 26 mg 4 times/day if necessary. Sublingual Angina pectoris Treatment for acute attacks: As tab: 300-600 mcg placed under the tongue; dose may be repeated at 5-minute intervals for a total of 3 doses. As aerosol spray (400 mcg/spray): 1-2 sprays under the tongue, then close the mouth, dose may be repeated at 5-minute intervals if required. Max: 3 doses. Prophylaxis: As tab: 300-600 mcg, 5-10 minutes prior to activities that may precipitate an attack. As aerosol spray (400 mcg/spray): 1 or 2 sprays, 5-10 minutes prior to activities. Seek medical care if symptoms are not resolved after a total of 3 doses. IV Induction of hypotension or control of hypertension during surgery Initial: 25 mcg/min via slow infusion, may be increased in increments of 25 mcg/min at 5-minute intervals. Usual dose range: 10-200 mcg/min, adjusted according to patient response. Max: 400 mcg/min. Acute myocardial infarction Initial: 15-20 mcg/min via slow infusion, then increased gradually by increments of 10-15 mcg/min until an adequate response is achieved. Congestive heart failure Initial: 20-25 mcg/min via slow infusion, may be decreased to 10 mcg/min, or increased in increments of 20-25 mcg/min every 15-30 minutes until desired response. Unstable angina pectoris Initial: 10 mcg/min via slow infusion, may increase in increments of 10 mcg/min at approx 30-minute intervals according to patient response. Rectal Chronic anal fissure As 0.2% ointment: Apply 1-1.5 cm strip of ointment into the anal canal tid. As 0.4% ointment: Apply 2.5 cm (approx 1.5 mg) 12 hourly for up to 8 weeks. Transdermal Prophylaxis of angina pectoris Monotherapy or combined with other anti-anginal treatment: As patch releasing 5 or 10 mg/24 hours: Apply 1 patch daily onto a fresh area of skin (e.g. chest, upper arms, thigh or shoulder). Max: 20 mg daily. Alternatively, 0.2-0.4 mg/hour initially then titrate to 0.4-0.8 mg/hour. Patch may remain on skin for 12-14 hours, followed by 10-12 hours patch-off period. Prophylaxis of phlebitis and extravasation secondary to venous cannulation As patch releasing 5 mg/24 hours: Apply 1 patch distal to the IV site, remove patch after 3-4 days, then apply replacement patch to a different area of the skin. Continue for as long as IV infusion is maintained. Topical Prophylaxis of angina pectoris As 2% ointment: Apply 1-2 inches 3-4 hourly as necessary, onto convenient area of the skin (e.g. chest, thigh, or arm), spread thinly without rubbing in. May cover the area after application. Dose may be titrated according to patient tolerance.
Contraindications
Hypertrophic obstructive cardiomyopathy, increased intracranial pressure (e.g. cerebral haemorrhage, head trauma), inadequate cerebral circulation, severe anaemia, closed-angle glaucoma, severe hypotension (systolic blood pressure <90 mmHg), arterial hypoxaemia, severe/uncontrolled hypovolaemia, extreme bradycardia, migraine or recurrent headache, acute circulatory failure and shock, cardiogenic shock with inadequate end-diastolic pressure, myocardial insufficiency due to obstruction, aortic or mitral stenosis, pericardial tamponade, constrictive pericarditis, toxic pulmonary oedema. Concomitant use with phosphodiesterase type 5 inhibitors (e.g. sildenafil), and riociguat.
Special Precautions
Patients with cerebrovascular disease, lung disease or cor pulmonale, recent history of MI, hypothyroidism, hypoxaemia or ventilation/perfusion imbalance due to lung disease or ischaemic heart failure, hypothermia, malnutrition, volume depletion, pre-existing hypotension, orthostatic dysfunction. Patch/topical ointment: Not indicated for treatment of acute angina attacks. Avoid abrupt withdrawal. Severe renal and hepatic impairment. Elderly. Pregnancy and lactation. Patient Counselling This drug may cause dizziness, light-headedness, headache, blurred vision, and postural hypotension; if affected, do not drive or operate machinery. Monitoring Parameters Monitor blood pressure and heart rate.
Adverse Reactions
Significant: Severe hypotension, shock, paradoxical bradycardia, increased intracranial pressure, dose-related headache, methaemoglobinaemia, drug tolerance, hypoxaemia. Ear and labyrinth disorders: Vertigo. Cardiac disorders: Tachycardia. Gastrointestinal disorders: Nausea, vomiting. General disorders and administration site conditions: Asthenia; application site reactions (e.g. irritation, rash, pruritus, erythema, burning or stinging sensation). Nervous system disorders: Dizziness, drowsiness, paraesthesia. Rarely, cerebral ischaemia. Psychiatric disorders: Restlessness. Vascular disorders: Orthostatic hypotension, flushing, syncope.
Drug Interactions
Enhanced hypotensive effects with other vasodilators and antihypertensives (e.g. ACE inhibitors, β-blockers, calcium channel blockers, diuretics), neuroleptics, TCAs, MAOIs, sapropterin, sublingual apomorphine. Increased vasodilating effects with N-acetylcysteine. Reduced absorption of sublingual nitrates with drugs that cause dry mouth (e.g. anticholinergics). May increase serum concentrations of ergot derivatives (e.g. dihydroergotamine). May diminish anticoagulant effect of heparin. May accelerate plasma clearance of tissue plasminogen activators (IV).
ATC Classification
C05AE01 - glyceryl trinitrate ; Belongs to the class of muscle relaxants. Used in the topical treatment for the treatment of hemorrhoids and anal fissures.
C01DA02 - glyceryl trinitrate ; Belongs to the class of organic nitrate vasodilators. Used in the treatment of cardiac disease.
Disclaimer: This information is independently developed by CIMS based on glyceryl trinitrate from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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