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Indication & Dosage |
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| Sublingual |
| MANAGEMENT OF ACUTE ANGINA |
| Adult:
As tab, 300-600 mcg, repeated if necessary. Seek medical help if persists after a total of 3 doses within 15 min Adult: As aerosol spray: 1-2 sprays of 400 mcg each directed onto or under the tongue, closing the mouth after spraying. No more than 3 metered-doses to be taken at any one time and minimum of 15 minutes interval between consecutive treatments. |
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| Oral |
| LONG-TERM MANAGEMENT OF STABLE ANGINA |
| Adult:
As modified-release preparation: 12.8 mg tab tid. |
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| Intravenous |
| MANAGEMENT OF UNSTABLE ANGINA |
| Adult:
Initially, 5-10 mcg/min. Usual dose range: 10-200 mcg/min. |
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| Intravenous |
| MANAGEMENT OF HEART FAILURE |
| Adult:
Initially, 5-25 mcg/min. |
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| Intravenous |
| TREATMENT OF MI AND INDUCTION OF HYPOTENSION OR CONTROL OF HYPERTENSION DURING SURGERY |
| Adult:
Initially, 5-25 mcg/min adjusted according to patient's response. Usual dose range: 10-200 mcg/min. |
| Max Dosage: 400 mcg/min. |
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| Transdermal |
| LONG-TERM MANAGEMENT OF STABLE ANGINA |
| Adult:
Apply one patch (releasing 2.5-20 mg/24 hr) onto the chest, upper arms, thigh, abdomen or shoulder. Replace with a new patch every 24 hr and rotate sites of application with every new patch. |
| Max Dosage: 20 mg daily |
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| Transdermal |
| PROPHYLACTIC TREATMENT OF PHLOEBITIS AND EXTRAVASATION SECONDARY TO VENOUS CANNULATION |
| Adult:
Apply 5-mg patch distal to the IV site, patch should be replaced at a different skin site either daily or after 3-4 days depending on the patch; continued for as long as the IV infusion is maintained. |
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| Topical/Cutaneous |
| LONG-TERM MANAGEMENT OF STABLE ANGINA |
| Adult:
Apply 0.5-2 inches of a 2% oint tid-qid or every 3-4 hr, if necessary, to the chest, arm, thigh or back |
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| Topical/Cutaneous |
| RELIEF OF PAIN DUE TO CHRONIC ANAL FISSURE |
| Adult:
As a 0.4% ointment: apply 1.5 mg intra-anally every 12 hr for up to 8 wk. |
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| Buccal |
| MANAGEMENT OF ACUTE ANGINA |
| Adult:
1-2 mg placed between the gum and upper lip, increased if necessary. |
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| Buccal |
| LONG-TERM MANAGEMENT OF STABLE ANGINA |
| Adult:
1-5 mg tid placed between the gum and upper lip. |
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| Buccal |
| MANAGEMENT OF HEART FAILURE |
| Adult:
5 mg placed between the gum and upper lip, repeated until symptoms are controlled. 5-10 mg tid may be given in chronic heart failure. |
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| Precautions |
Severe hepatic or renal impairment, hypothyroidism, malnutrition, hypothermia. Cerebrovascular disease, lung disease or cor pulmonale. Pregnancy, lactation, glaucoma, mitral valve prolapse, cardiac tamponade, syncope. Gradual withdrawal is advisable in patients who have received prolonged high dose infusions. Avoid prolonged excessive hypotension. Nitrate-free interval is recommended in patients on continuous treatment with nitrates to reduce the risk of tolerance. |
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Potentially Life-threatening
Adverse Drug Reactions |
Facial flushing, dizziness, tachycardia, throbbing headache and tolerance. Large dose can cause vomiting, restlessness, hypotension, syncope, rarely cyanosis and methaemoglobinaemia, impaired respiration, bradycardia. IV administration: IV prep contains substantial quantities of alcohol and alcohol intoxication can occur. Sublingual Tabs/Spray: Dry mouth, localized burning sensation. Topical: Contact dermatitis, erythema, local irritation. Transdermal patches: Contact dermatitis, metal-containing patches should be removed before cardioversion, defibrillation, diathermy. Buccal tablets: Delayed dissolution, may be swallowed by mistake. |
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| Adverse Drug Reactions |
Hypotension, paradoxical bradycardia, impaired respiration, syncope and collapse. |
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| Interactions |
Enhances bioavailability of dihydroergotamine. Glyceryl trinitrate infusion may prolong pancuronium-induced neuromuscular blockade. May reduce the efficacy of heparin, alteplase and noradrenaline when used together. Efficacy of buccal and sublingual preparations may be reduced by drugs that can cause dry mouth due to decreased dissolution. Aspirin and other NSAIDs may reduce the therapeutic response to glyceryl trinitrate. |
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