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04-19-2015, 03:50 PM
NITROGLYCERIN(GLYCERYL TRINIT)0.4MG/DOSE

* Composition: 11,2 g (12,2 ml) solution. 1 spray jet of 48 mg provides 0,4 mg glyceryl
trinitrate (nitroglycerin). Other ingredients: medium-chain triglycerides, medium-chain
partial glycerides, abs. ethanol, peppermint oil.
[1 spray dose of 48 mg provides 0.4 mg glyceryl trinitrate (nitroglycerin)]
* Pull the protective cap straight up. For spraying into the mouth under the tongue.
1 or 2 metered doses to be sprayed into the mouth under the tongue.
* Prescription medicine.
* Store below 25 degrees C.
Do not spray into flames or on any incandescent material.
Do not open the empty container by force or incinerate.

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Indications and dosages
https://www.glowm.com/resources/glowm/cd/graphics/drugs/arrow_bullet.gif Prophylaxis against chronic anginal attacks. Adults: 2.5 to 9 mg P.O. q 8 to 12 hours. Or, 1/2 inch of 2% ointment, increasing in 1/2-inch increments until desired effect is achieved. Range of dosage with ointment is 0.5 to 4 inches q 4 to 6 hours. Usual dose is 1 to 2 inches. Or, transdermal disc or pad may be applied to hairless site once daily. However, to prevent tolerance, topical forms shouldn’t be worn overnight.
https://www.glowm.com/resources/glowm/cd/graphics/drugs/arrow_bullet.gif Relief of acute angina pectoris, prophylaxis to prevent or minimize anginal attacks when taken immediately before stressful events. Adults: One S.L. tablet dissolved under the tongue or in the buccal pouch immediately after onset of anginal attack. May repeat q 5 minutes for 15 to 30 minutes for a maximum of three doses. Or, using Nitrolingual spray, spray one or two doses into mouth, preferably onto or under the tongue. May repeat q 3 to 5 minutes to a maximum of three doses within a 15-minute period. Or, transmucosally, 1 to 3 mg q 3 to 5 hours during waking hours.
https://www.glowm.com/resources/glowm/cd/graphics/drugs/arrow_bullet.gif Hypertension, heart failure, angina. Nitroglycerin is indicated to control hypertension related to surgery, to treat heart failure caused by MI, to relieve angina pectoris in acute situations, and to produce controlled hypotension during surgery (by I.V. infusion).
Adults: Initial infusion rate is 5 mcg/ minute. May be increased by 5 mcg/minute q 3 to 5 minutes until a response is noted. If a 20-mcg/ minute rate does not produce desired response, dosage may be increased by as much as 10 to 20 mcg/minute q 3 to 5 minutes.
https://www.glowm.com/resources/glowm/cd/graphics/drugs/arrow_bullet.gif Acute MI. Adults: Initially, 12.5 to 25 mcg I.V. followed by an infusion at 10 to 20 mcg/minute; increase 5 to 10 mcg/minute q 5 to 10 minutes as needed. Maximum dose is 200 mcg/minute. Decrease or discontinue if mean arterial pressure is under 80 mm Hg or systolic blood pressure under 90 mm Hg.
https://www.glowm.com/resources/glowm/cd/graphics/drugs/arrow_bullet.gif Hypertensive crisis ◇. Adults: Infuse at 5 to 100 mcg/minute I.V.

Pharmacodynamics
Antianginal action: Nitroglycerin relaxes vascular smooth muscle of both the venous and arterial beds, resulting in a net decrease in myocardial oxygen consumption. It also dilates coronary vessels, leading to redistribution of blood flow to ischemic tissue. Systemic and coronary vascular effects of drug, which may vary slightly with the various nitroglycerin forms, probably account for its value in treating angina.
Vasodilating action: Nitroglycerin dilates peripheral vessels, making it useful (in I.V. form) in producing controlled hypotension during surgical procedures and in controlling blood pressure in perioperative hypertension. Because peripheral vasodilation decreases venous return to the heart (preload), nitroglycerin also helps to treat pulmonary edema and heart failure. Arterial vasodilation decreases arterial impedance (afterload), thereby decreasing left ventricular work and aiding the failing heart. These combined effects may prove valuable in treating some patients with acute MI.

Pharmacokinetics
Absorption: Well absorbed from the GI tract. However, because it undergoes first-pass metabolism in the liver, it’s incompletely absorbed into the systemic circulation. Onset of action for oral preparations is slow (except for S.L. tablets). After S.L. administration, absorption from the oral mucosa is relatively complete. Nitroglycerin also is well absorbed after topical administration as an ointment or transdermal system.
Distribution: Distributed widely throughout the body. About 60% of circulating drug is bound to plasma proteins.
Metabolism: Metabolized in the liver and serum to 1,3 glyceryl dinitrate; 1,2 glyceryl dinitrate; and glyceryl mononitrate. Dinitrate metabolites have a slight vasodilatory effect.
Excretion: Metabolites are excreted in urine; elimination half-life is about 1 to 4 minutes.