Nitroglycerin Spray (Nitrolingual Spray)
Class
Vasodilator
Description
It was originally believed that nitrates and nitrites dilated coronary blood
vessels, thereby increasing blood flow to the heart. It is now believed that
atherosclerosis limits coronary dilation and that the benefits of nitrates and
nitrites result from dilation of arterioles and veins in the periphery. The
resulting reduction in preload and to a lesser extent in afterload decreases the
work load of the heart and lowers myocardial oxygen demand. Nitroglycerineis
very lipid soluble and is thought to enter the body from the GI tract through
thelymphatics rather than the portal blood.
Onset & Duration
Onset: 1-3 min.
Duration: 20-30 min.
Indications
1. Ischemic chest pain
2. Hypertensive emergency
3. Congestive heart failure, acute pulmonary edema
Contraindications
1. Systolic BP <100
2. Hypersensitivity
3. Pericardial tamponade
4. Constrictive pericarditis
5. Restrictive cardiomyopathy
6. Hypotension
7. Head injury
8. Cerebral hemorrhage
9. Severe brady/tachycardia
10. Hypovolemia
11. Aortic Stenosis
12. Right ventricular MI
13. Recent use of sildenafil
(Viagra™), Vardenafil
(Levitra™), or similar drugs for use in males or females
Adverse Reactions
1. Transient headache
2. Postural syncope
3. Reflex tachycardia
4. Hypotension
5. Nausea and vomiting
6. Allergic reaction
7. Muscle twitching
8. Diaphoresis
9. Recent sildenafil (Viagra™) use.
Drug Interactions
1. Other vasodilators may have additive hypotensive effects.
Special Considerations
1. Pregnancy safety: Category C
2. Susceptibility to hypotension in older adults increases.
3. Nitroglycerine decomposes when exposed to light or heat.
4. Must be kept in dark, airtight containers.
5. Active ingredient of nitroglycerine “stings” when administered SL
Note: Feel free to discuss this medication and your experiences in administering it in an emergency or hospital based setting on our message board
