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#建議持續輸注 (IV pump) 之高警訊藥品，本品須以非PVC管路 (NTG set) 輸注

治療心衰竭、心絞痛 Angina pectoris; acute decompensated heart failure; perioperative hypertension; induction of intraoperative hypotension

Antianginal Agent; Vasodilator
Nitroglycerin, an organic nitrate, is a vasodilating agent that relieves tension on vascular smooth muscle and dilates peripheral veins and arteries.

Distribution
1. Vd: 3 to 3.3 L/kg
2. Protein binding: Approximately 60%
Metabolism:
1. Hepatic: reductase, reduction, hydrolysis
2. Extrahepatic: RBCs and vascular walls
Excretion:
Total body clearance: 13.7 L/min

1. Hypersensitivity to nitroglycerin, other nitrates or nitrites, or any component of the formulation
2. Concurrent use with PDE-5 inhibitors (avanafil, sildenafil, tadalafil, or vardenafil) or soluble guanylate cyclase (sGC) stimulators (eg, riociguat)
3. Acute circulatory failure or shock; Constrictive pericarditis; restrictive cardiomyopathy; pericardial tamponade
4. Severe anemia
5. Increased intracranial pressure

1. IV nitroglycerin is recommended for use in pregnant females with preeclampsia when severe hypertension is associated with pulmonary edema
2. Based on its ability to produce smooth muscle relaxation, nitroglycerin may be used in obstetrical procedures when immediate relaxation of the uterus is needed, such as: uterine inversion following delivery, uterine relaxation during removal of retained placental tissue, and management of breech delivery

According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk and benefits.

Common:
Hypotension, flushing, dizziness, headache, lightheadedness
Serious:
Anaphylactoid reaction, methemoglobinemia, raised intracranial pressure

Acute angina:
Note: Consider IV therapy if angina is not relieved with other dosage forms. Avoid in patients with hypotension (eg, systolic BP <90 mm Hg or >30 mm Hg below baseline), marked bradycardia (eg, <50 beats per minute) or tachycardia (eg, >100 beats per minute), and/or suspected right ventricular infarction
1. Initial: 5 to 10 mcg/minute with continuous cardiac monitoring; titrate as needed to relieve angina symptoms in increments of 5 mcg/minute every 5 to 10 minutes up to 20 mcg/minute
2. If angina persists at a dose of 20 mcg/minute, may increase by 10 to 20 mcg/minute every 3 to 5 minutes to a maximum dose of 400 mcg/minute
Hypertension, perioperative (alternative agent):
Note: For patients with chronic hypertension prior to surgery, restart oral therapies as soon as appropriate once hemodynamically stable.
1. Initial: 5 to 10 mcg/minute; increase based on BP response and tolerability in increments of 5 mcg/minute every 3 to 5 minutes up to 20 mcg/minute
2. If no response at a dose of 20 mcg/minute, may increase by 10 to 20 mcg/minute every 3 to 5 minutes to a maximum dose of 200 mcg/minute
Acute decompensated heart failure (adjunctive therapy):
Initial 5 to 10 mcg/minute; titrate as needed based on response and tolerability in increments of 5 to 10 mcg/minute every 3 to 5 minutes up to a maximum of 200 mcg/minute

1. Only D5W or NS should be used as diluents.
2. All admixtures must be made in glass parenteral solution containers. Non-polyvinylchloride (PVC) tubing is recommended for administration since 40% to 80% of the calculated final concentration of nitroglycerin can be adsorbed by PVC sources, substantially affecting the actual delivered dose.