Medications
Nitroglycerin
Vasodilator for chest pain and acute cardiogenic pulmonary edema
Last updated: 2026-04-12Original source from BCEHS
Indications
Authorized
- Relief from chest pain suggestive of acute coronary syndrome
Contraindications
Authorized
- Known allergy or hypersensitivity to nitroglycerin
- Use of Viagra (sildenafil) or Levitra (vardenafil) within the previous 24 hours
- Use of Cialis (tadalafil) within the previous 48 hours
- Severe anemia
- Constrictive pericarditis or pericardial tamponade
- Documented right sided acute myocardial infarction
- Hypotension or uncorrected hypovolemia
- Systolic blood pressure <110 mmHg
- Heart Rate <50 or >150
Adult Dosages
Authorized
Relief from chest pain suggestive of acute coronary syndrome
CliniCall consultation consultation required prior to administration if the patient has no prior prescription for nitroglycerin or if more than 3 doses are required
- 0.4 mg SL every 3-5 minutes
- Verify systolic blood pressure prior to administering each dose; systolic blood pressure must be ≥ 110 mmHg and heart rate must be between 50 and 150 beats/minute
Pediatric Considerations
Not authorized for use in pediatrics
Adverse Effects
- Hypotension
- Headache
- Nausea
Additional Information
Mechanism of Action
Relaxes smooth muscle in vasculature. Nitroglycerin works primarily as a venodilator, but can also produce coronary and systemic arterial vasodilation, decreasing preload and lowering myocardial oxygen demand.
Pharmacokinetics
| Route | Onset | Peak | Duration |
|---|---|---|---|
| SL | 30 seconds - 2 minutes | 5-10 minutes | 15-30 minutes |
| IV | 30 seconds - 1 minute | 3-5 minutes | 15-30 minutes |
Warnings and Precautions
- Do not administer to patients with a blood pressure <110 mmHg or who are exhibiting signs of significant hypoperfusion.
- Use with caution in patients with hepatic or renal insufficiency.
- Exercise caution (and rule out right-sided involvement) in patients with documented inferior ischemia on 12-lead ECG.
- Exercise caution in patients with clinically significant aortic stenosis.
Drug Interactions
Antihypertensive agents may act synergistically with nitroglycerin.