Medication Guide App

Nitroglycerin Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Angina Pectoris

For relief of acute anginal attack:

Lingual spray: 1 to 2 sprays (0.4 to 0.8 mg) onto or under the tongue every 3 to 5 minutes as needed, up to 3 sprays in 15 minutes. If pain persists after the maximum number of doses, prompt medical attention is recommended.

Sublingual tablet: 0.3 to 0.6 mg dissolved under the tongue or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes. If pain persists after the maximum number of doses, prompt medical attention is recommended.

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed, up to a usual maximum of 200 and generally no more than 400 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Angina Pectoris Prophylaxis

Lingual spray: 1 to 2 sprays (0.4 to 0.8 mg) onto or under the tongue 5 to 10 minutes prior to engaging in activities which might precipitate an acute attack

Sublingual tablet: 0.3 to 0.6 mg dissolved under the tongue or in the buccal pouch 5 to 10 minutes prior to engaging in activities which might precipitate an acute attack

Topical ointment: 1/2 inch initially, applied to a non hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. If angina occurs while the ointment is in place, the dose should be increased; if angina occurs several hours after application, the dosing frequency should be increased. Usual range is 1/2 to 2 inches (7.5 to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.

Transdermal patch: 0.1 to 0.4 mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr. Application sites should be rotated to avoid skin irritation.

Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. If angina occurs while a tablet is in place, the dose should be increased to the next strength; if angina occurs after dissolution of tablet, the dosing frequency should be increased. Usual maintenance dosage is 2 mg three times a day. If an acute attack occurs while a tablet is in place, another tablet may be administered on the opposite side from the one already in place. Sublingual nitroglycerin is recommended if prompt relief is not attained.

Oral: 2.5 every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours

Because tolerance to nitroglycerin may develop if plasma levels are maintained continuously, a nitrate free interval of 10 to 12 hours per day may be appropriate during chronic prophylaxis of angina pectoris. However, clinical studies suggest that such intermittent use may be associated with hemodynamic rebound during drug withdrawal and decreased exercise tolerance during the latter part of the nitrate free interval. Although the clinical relevance of this observation is unknown, a potentially increased risk of anginal attack during the nitrate free interval should be considered. Therefore, dosing regimens should be carefully individualized to each patient. Other antianginal drugs such as beta-blockers and calcium channel blockers may be prescribed to reduce the risk of aggravating myocardial ischemia during the drug free intervals.

Usual Adult Dose for Congestive Heart Failure

Topical ointment: 1/2 inch initially, applied to a non hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. Usual range is 1/2 to 2 inches (7.5 to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.

Transdermal patch: 0.1 to 0.4 mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr. Application sites should be rotated to avoid skin irritation.

Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. Usual maintenance dosage is 2 mg three times a day.

Oral: 2.5 every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours

Usual Adult Dose for Myocardial Infarction

For the initial 24 to 48 hours after an acute myocardial infarction:

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed up to a usual maximum of 200 and generally no more than 400 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Hypertension

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed up to a usual maximum of 100 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Anal Fissure and Fistula

For the treatment of moderate to severe pain associated with chronic anal fissure:
Apply 1 inch of ointment (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) intra anally every 12 hours for up to 3 weeks.

Usual Pediatric Dose for Hypertension

Perioperative hypertension or induction of intraoperative hypotension:

IV continuous infusion: 0.25 to 0.5 mcg/kg/min initially, increase by 0.5 to 1 mcg/kg/min every 3 to 5 minutes as needed up to 5 mcg/kg/min. Usual dose is 1 to 3 mcg/kg/min, but doses as high as 20 mcg/kg/min have been used.

Renal Dose Adjustments

No dosage adjustment is required in patients with renal failure.

Liver Dose Adjustments

Data not available

Precautions

Transdermal, topical and oral extended-release formulations of nitroglycerin should not be used to treat acute angina attacks.

Intravenous nitroglycerin should be administered by non PVC tubing to minimize absorption of the drug into the tubing. Higher dosages are generally required if PVC administration sets are used so as to compensate for loss of drug into the plastic. As such, dosages in published studies utilizing general use PVC administration sets will be too high when low absorbing infusion sets are used.

Dialysis

Data not available

Other Comments

Because of their fast onset of action, sublingual, lingual and buccal formulations of nitroglycerin should be administered while the patient is sitting down.

Sublingual and buccal tablets of nitroglycerin should not be chewed or swallowed. In the event that a tablet is swallowed when treating an acute attack, the dose may be repeated via the appropriate route of administration.

Lingual metered spray should not be inhaled or swallowed. The metered spray should be primed prior to administration with one spray initially and every 6 weeks if not used within that period.

During IV infusion, blood pressure and heart rate should be continually monitored, and adequate systemic blood pressure and coronary perfusion pressure must be maintained.

Hide
(web5)