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Nitroglycerin (Monograph)

Brand names: Nitro-Bid, Nitro-Dur, NitroMist, Nitrostat
Drug class: Nitrates and Nitrites

Medically reviewed by Drugs.com on Oct 10, 2024. Written by ASHP.

Introduction

Nitroglycerin, an organic nitrate, is a vasodilating agent.

Uses for Nitroglycerin

Angina

Management of angina pectoris secondary to CAD.600 802 806 807 809

Short-acting preparations (e.g., sublingual tablets, lingual aerosol or spray) are used for acute relief of angina; also may be used for acute prophylactic management in situations likely to provoke angina attacks.802 806 807 809

The ointment and transdermal preparations are indicated for prevention of angina due to coronary artery disease; the onset of action of these dosage forms is not sufficiently rapid enough to abort an acute anginal episode.216 600

Expert guidelines recommend antianginal therapy with either a β-blocker, calcium channel blocker, or long-acting nitrate for relief of angina in patients with chronic coronary disease.1101 Sublingual nitroglycerin or nitroglycerin spray is recommended for immediate short-term relief of angina.1101

Nitroglycerin also is used for relief of angina in patients with non-ST-segment-elevation MI (NSTEMI) or ST-segment-elevation MI (STEMI).217 218 240 241 242 527 1100

Expert guidelines recommend sublingual nitroglycerin (0.3–0.4 mg every 5 minutes for up to 3 doses) for relief of ongoing ischemic pain in patients with NSTEMI; IV nitroglycerin may be used in patients with heart failure, hypertension, or persistent ischemia not relieved with sublingual nitroglycerin and administration of a β-blocker.1100 Topical nitrates may be an acceptable alternative to IV therapy in patients who do not have refractory or recurrent ischemia.1100

Guidelines also state that IV nitroglycerin may be beneficial in patients with ST-segment-elevation MI (STEMI) and heart failure or hypertension.527

Hypertension

IV nitroglycerin is used for treatment of perioperative hypertension and for induction of intraoperative hypotension.811 812

IV nitroglycerin also has been used to control BP in perioperative hypertension, especially hypertension associated with cardiovascular procedures; to control BP in patients with severe hypertension† [off-label] or in hypertensive crises† [off-label] for the immediate reduction of BP in patients in whom such reduction is considered an emergency (hypertensive emergencies), especially those associated with coronary complications (e.g., coronary ischemia, acute coronary insufficiency, acute left ventricular failure, postoperative hypertension [especially following coronary bypass surgery]) and/or acute pulmonary edema; and to produce controlled hypotension during surgical procedures.500 812 502 1200

Heart Failure and Low-output Syndromes

IV nitroglycerin has been used in the management of acutely decompensated (e.g., congestive) heart failure and other low cardiac-output states† [off-label].524

Current guidelines recommend a combination of drug therapies (e.g., ACE inhibitors, angiotensin II receptor antagonists, angiotensin receptor-neprilysin inhibitors [ARNIs], β-blockers, aldosterone receptor antagonists) in adults with heart failure to reduce morbidity and mortality.524 701 703 800

IV vasodilators not shown to improve outcomes in patients hospitalized for heart failure; however, IV nitroglycerin may be considered as adjunct to diuretic therapy for relief of dyspnea in patients hospitalized for acutely decompensated heart failure who do not have symptomatic hypotension.524

Particularly useful in patients with heart failure and hypertension, coronary ischemia, or substantial mitral regurgitation.524

Tachyphylaxis may develop within 24 hours; some patients may develop resistance to even high doses.524

Nitroglycerin Dosage and Administration

Administration

Administer lingually, sublingually, topically, or by IV infusion.216 600 806 807 809 811 812

Lingual Administration

Administer nitroglycerin lingual preparations (aerosol or solution) using a metered-dose spray pump.806 807

Spray lingual aerosol or solution onto or under tongue and immediately close mouth; do not inhale spray.806 807

Do not expectorate the drug or rinse the mouth for 5–10 minutes following administration.806 807

Lingual nitroglycerin may be inadequately absorbed, with resultant decreased efficacy, in patients with dry oral mucous membranes (e.g., xerostomia).219 220

Sublingual Administration

Sublingual tablets are dissolved under the tongue.809 Do not swallow.809

Sublingual nitroglycerin may be inadequately absorbed, with resultant decreased efficacy, in patients with dry oral mucous membranes (e.g., xerostomia).219 220

Transdermal Administration (Transdermal System)

Apply nitroglycerin transdermal system topically to the skin as directed by manufacturer.216

Preferably apply at same time each day to areas of clean, dry, hairless skin of the upper arm or body; do not apply to extremities below knee or elbow.216

Avoid skin areas with irritation, extensive scarring, or calluses; rotate application sites to avoid skin irritation.216

Remove transdermal systems from site(s) of application prior to defibrillation or cardioversion since altered electrical conductivity and enhanced potential for electrical arcing may occur.216 205 206 207

Topical Administration (Ointment)

Apply topically using manufacturer-supplied applicator.600

Spread on any non-hairy skin area (usually the chest or back) in a thin, uniform layer without massaging or rubbing.600 Tape applicator into place on skin.600

Application of the ointment over the chest may provide additional psychological effect.600

Avoid placement of ointment on areas of chest where defibrillation paddles typically are placed due to potential for altered electrical conductivity.206

IV Administration

Because nitroglycerin readily migrates into many plastics, the manufacturers’ specific instructions for dilution, dosage, and administration must be carefully followed. 811 812

Do not admix with other drugs.811 812

Dilution

Must dilute commercially available injection concentrate in 5% dextrose or 0.9% sodium chloride injection before administration.811 812

Dilute and store only in glass bottles; avoid using filters since some filters absorb nitroglycerin.811 812

Standardize 4 Safety

Standardized concentrations for nitroglycerin have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care.49 50 Because recommendations from the S4S panels may differ from the manufacturer’s prescribing information, caution is advised when using concentrations that differ from labeling, particularly when using rate information from the label.49 50 For additional information on S4S (including updates that may be available), see [Web].49 50

Table 1: Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Nitroglycerin4950

Patient Population

Concentration Standards

Dosing Units

Adults

200 mcg/mL

mcg/min

Pediatric patients (<50 kg)

200 mcg/mL

mcg/kg/min

400 mcg/mL

Dosage

Carefully adjust dose according to the patient’s requirements and response; use smallest effective dosage.811 812

For IV administration, must consider the type of IV administration set used (PVC or non-PVC) in dosage estimations.811 812 IV dosages commonly used in early published studies were based on the use of PVC administration sets and are too high when non-PVC administration sets are used. 811 812

Continuously monitor BP, heart rate, and other appropriate parameters (e.g., pulmonary capillary wedge pressure).811 812 Must maintain adequate systemic BP and coronary perfusion pressure. 811 812

Some patients with normal or low left ventricular filling pressures or pulmonary capillary wedge pressure may be extremely sensitive to the effects of IV nitroglycerin and may respond fully to dosages as low as 5 mcg/minute; these patients require particularly careful monitoring and dosage titration.811 812

Adults

Angina
Acute Symptomatic Relief and Acute Prophylactic Management
Lingual

1 or 2 sprays (0.4 or 0.8 mg, respectively) as a lingual solution or aerosol at the onset of an attack.806 807

May give additional single sprays at intervals of approximately every 5 minutes as necessary if relief is not attained after initial spray(s);806 807 do not exceed 3 sprays in a 15-minute period.806 807

If pain persists after a total of 3 doses within a 15-minute period, seek prompt medical attention.806 807

If used prophylactically, may administer 5–10 minutes before situations likely to provoke angina attacks.806 807

Sublingual

Sublingual tablets: 0.3–0.6 mg at the first sign of an acute anginal attack.809 If relief not attained after a single dose, may give additional doses at 5-minute intervals.809 If pain persists after a total of 3 doses within a 15-minute period, or if the pain is different from that typically experienced, seek prompt medical attention.809

If used prophylactically, may administer a dose of nitroglycerin (as sublingual tablets) 5–10 minutes before engaging in activities likely to provoke angina attacks.809

Long-term Prophylactic Management of Angina
Topical (Transdermal System)

Initially, one transdermal dosage system applied every 24 hours, using system delivering the smallest available dose of nitroglycerin in its dosage series.216

Nitrate-free interval of 10–14 hours recommended to minimize occurrence of tolerance; however, the minimum nitrate-free interval necessary for restoration of full first-dose effects not determined.601

May adjust dosage by changing to the next larger dosage system in the series or using a combination of dosage systems in the series.216

Do not use transdermal systems to treat acute attacks of angina.216

Topical (Ointment)

2% Ointment: Initially, 0.5 inch (approximately 7.5 mg), as squeezed from the tube, twice daily (once in the morning and repeat in 6 hours), suggested.600 When dose to be applied is in multiples of whole inches, may use unit-dose preparations that provide the equivalent of 1 inch of the 2% ointment.600

May double dose to 1 inch (approximately 15 mg) and subsequently double again to 2 inches (approximately 30 mg) if tolerated to achieve adequate response.600

Titrate dosage upward until angina is effectively controlled or adverse effects preclude further increases.600

Amount of nitroglycerin reaching the circulation varies directly with the size of application area and amount of ointment applied.600 Generally, spread over an area approximately the size of the applicator (3.5 by 2.25 inches); however, may use a larger area (e.g., 6 by 6-inch area).600

To minimize the occurrence of tolerance to the effects of nitroglycerin, a nitrate-free interval of 10–14 hours has been recommended; however, the minimum nitrate-free interval necessary has not been determined.600 601 602

Do not use ointment to treat acute attacks of angina.600

IV

Manufacturer states usual initial dosage is 5 mcg/minute when using a nonadsorptive (e.g., non-PVC) administration set; increase by 5 mcg/minute every 3–5 minutes until BP response is obtained or infusion rate is 20 mcg/minute.812 If no effect is obtained with 20 mcg/minute, may increase dosage by increments of 10 mcg/minute or, if necessary, by 20 mcg/minute.812 Higher dosages generally required when a PVC administration set is used; manufacturer states usual initial dosage is 25 mcg/minute with such administration sets.812 Titrate dosage according to patient's response.812

NSTE ACS
Sublingual, then IV (if necessary)

0.3–0.4 mg every 5 minutes for up to 3 doses as a sublingual preparation in patients with continuing ischemic pain.1100 Assess need for IV nitroglycerin, if not contraindicated.1100

IV

IV nitroglycerin may be useful in patients with heart failure, hypertension, or persistent ischemia not relieved with sublingual nitroglycerin and administration of a β-blocker.1100

Manufacturer states usual initial dosage is 5 mcg/minute when using a nonadsorptive (e.g., non-PVC) administration set; increase by 5 mcg/minute every 3–5 minutes until BP response is obtained or infusion rate is 20 mcg/minute.812 If no effect is obtained with 20 mcg/minute, may increase dosage by increments of 10 mcg/minute or, if necessary, by 20 mcg/minute.812 Higher dosages generally required when a PVC administration set is used; manufacturer states usual initial dosage is 25 mcg/minute with such administration sets.812 Titrate dosage according to patient's response.812

Continuously monitor BP and heart rate during administration.812

STEMI
IV

Some experts recommend continuous IV infusion at an initial rate of 10 mcg/minute, increasing the dosage as necessary based on hemodynamic and clinical response.527 Dosage will vary considerably among patients; adjust based on individual requirements, BP response, and adverse effects.527 812

Manufacturer states the recommended initial dosage is 5 mcg/minute when using a nonadsorptive (e.g., non-PVC) administration set; increase by 5 mcg/minute every 3–5 minutes until BP response is obtained or infusion rate is 20 mcg/minute.812 If no effect is obtained with 20 mcg/minute, may increase dosage by increments of 10 mcg/minute or, if necessary, by 20 mcg/minute.812 Higher dosages generally required when a PVC administration set is used; manufacturer states usual initial dosage is 25 mcg/minute with such administration sets.812 Titrate dosage according to patient's response.812

Continuously monitor BP and heart rate during administration.812

Hypertension
Perioperative Hypertension or Induction of Intraoperative Hypotension
IV

Initially, 5 mcg/minute (per manufacturer) when using a nonadsorptive (e.g., non-PVC) administration set; increase by 5 mcg/minute every 3–5 minutes until BP response is obtained or infusion rate reaches 20 mcg/minute.812 If no effect is obtained with 20 mcg/minute, may increase dosage by increments of 10 mcg/minute or, if necessary, by 20 mcg/minute.812 Higher dosages generally required when a PVC administration set is used; manufacturer states initial dosage of 25 mcg/minute or greater has been used in studies with such administration sets.812 Titrate dosage according to patient's response and possible adverse effects.812

Hypertensive Emergency† [off-label]
IV

Initially, 5 mcg/minute according to some experts; increase by 5 mcg/minute every 3–5 minutes until BP response is obtained or infusion rate reaches 20 mcg/minute.1200

Always consider the risks of overly aggressive therapy in any hypertensive crisis.542 1200

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment.216 600 806 807 809

Renal Impairment

No dosage adjustments necessary for renal impairment.809

Geriatric Patients

Cautious dosage selection, usually starting at the low end of the dosing range, because of possible age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.809

Detailed Nitroglycerin dosage information

Cautions for Nitroglycerin

Contraindications

Warnings/Precautions

Warnings

Concomitant Use with Selective Phosphodiesterase (PDE) Inhibitors

Selective PDE type 5 inhibitors can potentiate the hypotensive effects of organic nitrates and nitrites, possibly resulting in potentially life-threatening hypotension and/or hemodynamic compromise.809

PDE type 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil) are contraindicated in patients receiving organic nitrates or nitrites in any form (e.g., orally, sublingually, transmucosally, parenterally), given regularly or intermittently,262 or nitric oxide donors since severe, potentially fatal hypotensive episodes can occur.260 261 262 263 266 271 272 282 284 285 288

Clinicians unfamiliar with their patients’ drug history, especially those involved in emergency care (e.g., for presumed MI or ischemia), should take a careful history so that concomitant use of organic nitrates or nitrites with selective PDE inhibitors can be avoided.260 264 271

Warn all patients receiving organic nitrates or nitrites about the potential interaction between the drugs and selective PDE inhibitors, even if they currently are not receiving the drugs, since there is substantial potential for patients to receive the drugs from another clinician, from a friend, with little or no clinical intervention (e.g., via the Internet),281 or illicitly.260 281 282

Warn all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potential consequences of taking the drugs within close proximity (e.g., within 24 hours of sildenafil; possibly more prolonged periods of risk with longer-acting PDE inhibitors) of taking a nitrate- or nitrite-containing preparation.260 282

Concomitant Use with sGC Stimulators

Concomitant use of nitrates (e.g., nitroglycerin) or nitrites (e.g., amyl nitrite) with a sGC stimulator (e.g., riociguat) can cause additive hypotensive effects.804 807 Such concomitant use is contraindicated.804 807

Cardiovascular Effects

Severe hypotension, particularly in upright position, can occur even with low nitroglycerin doses, particularly in the elderly.807 809

Use with caution in patients who are volume depleted or have preexisting hypotension.807 809

Paradoxical bradycardia and angina exacerbation may accompany hypotension.807 809

Benefits in acute MI and CHF not established.216 600 If used in these conditions, careful clinical or hemodynamic monitoring for possible hypotension or tachycardia is recommended.216 600

Avoid long-acting dosage forms in the early management of acute MI or CHF since the effects are difficult to terminate rapidly should excessive hypotension or tachycardia occur.c

Sensitivity Reactions

Contact dermatitis or fixed drug eruptions reported in patients receiving nitroglycerin ointment or transdermal system.216 600 Anaphylactoid reaction reported; possibly may occur with any route.216 600

General Precautions

Tolerance and Dependence

Tolerance to the vascular and antianginal effects of individual nitrates and cross-tolerance among the drugs may occur with repeated, prolonged use or excessive doses.807 809

Intermittent dosing of nitrates (e.g., use of a nitrate-free interval of 10–14 hours daily) has been used in an attempt to minimize or prevent the development of tolerance to the hemodynamic and antianginal effects of the drugs.601

Nitrate dependence is possible; withdrawal manifestations (e.g., ischemic symptoms, MI, sudden death) can occur.600 During the nitrate-free intervals in some trials, anginal attacks have been more easily provoked than before treatment, and patients have demonstrated hemodynamic rebound and decreased exercise tolerance.600

Specific Populations

Pregnancy

Sublingual tablets: Category B.809 Sublingual nitroglycerin has been used for the treatment of angina during pregnancy without fetal harm.825

Lingual aerosol, lingual solution, ointment, transdermal system: Category C.600 806 807

Injection: Data regarding pregnancy lacking. 812

Some experts state that use of nitroglycerin during pregnancy does not appear to present a risk to the fetus; however, experience with the drug in pregnant women is limited.809 825 Use during pregnancy only if clearly needed.806 807 809

Lactation

Not known whether nitroglycerin is distributed into milk.809 The low molecular weight of nitroglycerin suggests that some distribution into milk may occur.825 Caution if used in nursing women.809

Pediatric Use

Safety and efficacy not established in pediatric patients.807 809

Geriatric Use

Clinical studies did not include sufficient numbers of individuals ≥65 years of age to determine whether they respond different than younger adults.809

May aggravate angina caused by hypertrophic cardiomyopathy, particularly in the elderly.807

Cautious dosage selection, usually starting at the low end of the dosing range, because of possible age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.809

Common Adverse Effects

Headache (pulsating or throbbing sensation, potentially severe); hypotension (may cause dizziness, weakness, other signs of cerebral ischemia); cutaneous vasodilation with transient flushing.807 809 c

Drug Interactions

Specific Drugs or Laboratory Tests

Drug or Test

Interaction

Comments

Alcohol

Concomitant use may cause hypotensionc

Use concomitantly with cautionc

Aspirin

High-dose aspirin (1 g) may increase exposure to nitroglycerin and enhance its vasodilatory and hemodynamic effects806

Antihypertensive drugs

Possible additive hypotensive effectsc

Dosage adjustment of either the nitrate/nitrite or the other agent with hypotensive activity may be necessary to avoid orthostatic hypotension during concomitant usec

Ergot alkaloids (dihydroergotamine)

Dihydroergotamine may counteract the coronary vasodilatory effect of nitrates303 316

Risk of angina precipitation316 806 807

Concomitant use not recommended316 806 807

Heparin

Because some,203 204 245 247 but not all,246 evidence indicates that IV nitroglycerin may antagonize the anticoagulant effect of heparin when these drugs are administered concomitantly, exercise caution203 204 245 247 812

Closely monitor patients receiving heparin and IV nitroglycerin concomitantly (e.g., measure APTT) to avoid inadequate anticoagulation203 204 236 245 246 247

If IV nitroglycerin therapy is discontinued in patients receiving heparin, reduction in heparin dosage may be necessary204 263 245 246 247

Nitrites

Observe patients receiving nitrates or nitrites concomitantly for possible additive hypotensive effectsc

Dosage adjustment of either the nitrate/nitrite or the other agent with hypotensive activity may be necessary to avoid orthostatic hypotension during concomitant usec

Phenothiazines

Possible additive hypotensive effectsc

Use concomitantly with caution; may need to adjust dosage to avoid orthostatic hypotension c

Phosphodiesterase (PDE) type 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)

Selective PDE type 5 inhibitors profoundly potentiate the vasodilatory effects (e.g., a >25-mm Hg decrease in SBP) of organic nitrates and nitrites (e.g., nitroglycerin, isosorbide dinitrate), and potentially life-threatening hypotension and/or hemodynamic compromise can result259 260 261 262 263 264 266 271 272 274 275 282 284 285

Combined use is contraindicated259 260 261 262 282 287

Some experts state that coadministration of PDE type 5 inhibitors with long-acting nitrates should be strictly avoided within 24 hours of nitrate administration; nitrates should not be taken for 24 hours after use of sildenafil or 48 hours after tadalafil

If a nitrate or nitrite is administered after a PDE inhibitor (e.g., >24 hours after sildenafil use), carefully monitor response to the initial doses and ensure proper facilities for fluid and vasopressor (e.g., α-adrenergic agonists) support are readily available260 289 334

Riociguat

Possible additive hypotensive effect804 807

Concomitant use contraindicated804 807

Thrombolytic agents

Concomitant administration of tissue-type plasminogen activator (t-PA) and IV nitroglycerin reduces plasma levels of t-PA and its thrombolytic effect806

Use concomitantly with caution806
Nitroglycerin drug interactions (more detail)

Nitroglycerin Pharmacokinetics

Absorption

Bioavailability

Absorbed percutaneously through skin and oral mucosa.216

Topical (transdermal system) provides continuous, controlled release of nitroglycerin to the skin where the drug undergoes percutaneous absorption.216

Rates of delivery and absorption of nitroglycerin from transdermal systems vary depending on the specific preparation; consult the individual manufacturers’ information.216

Onset and Duration

The approximate onset and duration of action of various dosage forms of nitroglycerin are as follows:c

Antianginal Effects

Dosage Form

Onset

Duration

Sublingual

within 2 min

up to 30 min

Topical ointment

30 min

3 h

Oral extended-release

1 h

up to 12 h
Hemodynamic Effects

Dosage Form

Onset

Duration

Sublingual

2 min

up to 30 min

Topical ointment

within 1 h

3–6 h

Plasma Concentrations

Following topical application of transdermal system, steady-state plasma concentrations attained by about 2 hours;216 prolonged onset compared with other currently available dosage forms.216

Distribution

Extent

Unknown if nitroglycerin is distributed into milk.807 809

Plasma Protein Binding

Nitroglycerin: about 60% bound.809

Elimination

Metabolism

Metabolized to 1,3-glyceryl dinitrate, 1,2-glyceryl dinitrate, and glyceryl mononitrate.

Glyceryl mononitrate, which is inactive, is the principal metabolite.

Dinitrate metabolites are metabolized further to inactive mononitrates and are metabolized ultimately to glycerol and carbon dioxide.

Extrahepatic sites of metabolism include red blood cells and vascular walls.

Half-life

Nitroglycerin: 1–4 minutes.

Stability

Handle undiluted nitroglycerin cautiously since it is a powerful explosive that can be exploded by percussion or excessive heat.

Storage

Oral

Sublingual Tablets

Store in original glass container at 20–25°C.809

Advise patients to keep sublingual tablets in the original container and to close it tightly immediately after each use in order to prevent loss of potency.809

Lingual Aerosol

Store at 25°C (may be exposed to 15–30°C).806

Contains a highly flammable propellant (butane); do not forcefully open container, spray toward a flame, or place into a fire for disposal.806

Lingual Solution in Spray Pump

Store at 25°C (may be exposed to 15–30°C).807

Contains 20% alcohol; do not forcefully open container, spray toward a flame, or place into a fire or incinerator for disposal.807

Topical

Ointment

Tight containers at 20–25°C.600

Advise patients to tightly close multiple-dose containers of nitroglycerin ointment immediately after each use.600

Transdermal System

Sealed, single-dose containers at 15–30°C; avoid temperature extremes and/or humidity.216

Parenteral

IV Solutions

Concentrate for injection: store at 15–30°C; avoid freezing.812

Premixed solution in 5% dextrose injection: 25°C; avoid freezing and excessive heat.812

Actions

Advice to Patients

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Nitroglycerin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Lingual

Aerosol

0.4 mg/spray*

Nitroglycerin Lingual Aerosol

NitroMist

Mist

Solution

0.4 mg/spray*

Nitroglycerin Lingual Spray

Nitrolingual Pumpspray

Arbor

Parenteral

For injection concentrate, for IV infusion

5 mg/mL (50 mg)

Nitroglycerin Injection

Sublingual

Tablets

0.3 mg*

Nitroglycerin Sublingual Tablets

Nitrostat

Pfizer

0.4 mg*

Nitroglycerin Sublingual Tablets

Nitrostat

Pfizer

0.6 mg*

Nitroglycerin Sublingual Tablets

Nitrostat

Pfizer

Topical

Ointment

2%

Nitro-Bid

Fougera

Transdermal System

0.1 mg/hour (total nitroglycerin content and transdermal system size may vary by manufacturer)*

Nitro-Dur

Ingenus

Nitroglycerin Transdermal System

0.2 mg/hour (total nitroglycerin content and transdermal system size may vary by manufacturer)*

Nitro-Dur

Ingenus

Nitroglycerin Transdermal System

0.3 mg/hour (60 mg/15 cm2)

Nitro-Dur

Ingenus

0.4 mg/hour (total nitroglycerin content and transdermal system size may vary by manufacturer)*

Nitro-Dur

Ingenus

Nitroglycerin Transdermal System

0.6 mg/hour (total nitroglycerin content and transdermal system size may vary by manufacturer)*

Nitro-Dur

Ingenus

Nitroglycerin Transdermal System

0.8 mg/hour (160 mg/40 cm2)

Nitro-Dur

Ingenus

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Nitroglycerin in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV use only

100 mcg/mL (25 or 50 mg) Nitroglycerin in 5% Dextrose*

Nitroglycerin in 5% Dextrose Injection

200 mcg/mL (50 mg) Nitroglycerin in 5% Dextrose*

Nitroglycerin in 5% Dextrose Injection

400 mcg/mL (100 or 200 mg) Nitroglycerin in 5% Dextrose*

Nitroglycerin in 5% Dextrose Injection

AHFS DI Essentials™. © Copyright 2025, Selected Revisions October 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

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