Acute & chronic CHF (including that associated w/ MI). Patients w/ increased left ventricular end diastolic pressure. Tab Prophylaxis of ischemic heart pain associated w/ coronary insufficiency. SL tab Treatment of angina pectoris & for prophylaxis in situations likely to provoke an angina attack ie, physical or emotional stress.
Angina pectoris Tab 5-30 mg qid. SL tab 5-10 mg every 2-3 hr as prophylaxis. May be supplemented by 5-10 mg prior to stressful situations likely to provoke an attack. Acute CHFTab 10-40 mg qid or as needed. SL tab 5-10 mg every 2 hr or as needed. Chronic CHF Initially 5-10 mg by SL every 2 hr or as needed. Maintenance: 20-40 mg qid orally or as needed.
Paradoxical side effects in sensitive patients. Hemodynamic monitoring & frequent clinical assessment w/ the use of organic nitrates in early infarction. Severe hypotensive response. Paradoxical bradycardia & increased angina pectoris may accompany nitrate-induced hypotension. Blood vol depletion from diuretic therapy; low systolic BP (eg, <90 mmHg). Monitor pulmonary capillary pressure not to fall below 15 mmHg or systolic BP below physiological range. In combination w/ Ca channel blockers. May aggravate angina caused by hypertrophic cardiomyopathy. Tolerance & cross-tolerance to other nitrates & nitrites may occur. Avoid abrupt w/drawal. Pregnancy & lactation. Childn. Elderly.
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