Formulary
Glyceryl trinitrate: Indications, Dosing, Side Effects and Interactions
Glyceryl trinitrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Glyceryl trinitrate: Indications, Dosing, Side Effects and Interactions
Glyceryl trinitrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Prophylaxis of angina**
- **Adult** (By Transdermal Application): One '5' or one '10' patch to be applied to lateral chest wall and replaced every 24 hours, siting replacement patch on different area, max. two '10' patches daily.
**Control of hypertension and myocardial ischaemia during and after cardiac surgery,Induction of controlled hypotension during surgery,Congestive heart failure,Unstable angina**
- **Adult** (By Intravenous Infusion): 10-200 micrograms/minute (max. per dose 400 micrograms/minute), adjusted according to response, consult product literature for recommended starting doses specific to indication.
**Anal fissure**
- **Adult** (By Rectum Using Ointment): Apply 2.5 centimetres every 12 hours until pain stops. Max. duration of use 8 weeks, apply to anal canal, 2.5 cm of ointment contains 1.5 mg of glyceryl trinitrate.
**Maintenance of venous patency ('5' patch only)**
- **Adult** (By Transdermal Application): (consult product literature).
**Prophylaxis of phlebitis and extravasation ('5' patch only)**
- **Adult** (By Transdermal Application): (consult product literature).
**Hypertension during and after cardiac surgery, Heart failure after cardiac surgery, Coronary vasoconstriction in myocardial ischaemia, Vasoconstriction in shock for glyceryl trinitrate**
- **Neonate** (By continuous intravenous infusion): 0.2-0.5 microgram/kg/minute, adjusted according to response, maintenance 1-3 micrograms/kg/minute (max. per dose 10 micrograms/kg/minute).
- **Child** (By continuous intravenous infusion): Initially 0.2-0.5 microgram/kg/minute, adjusted according to response, maintenance 1-3 micrograms/kg/minute (max. per dose 10 micrograms/kg/minute); maximum 200 micrograms/minute.
Cautions
Heart failure due to obstruction; hypothermia; hypothyroidism; hypoxaemia; malnutrition; metal-containing transdermal systems should be removed before magnetic resonance imaging procedures, cardioversion, or diathermy; recent history of myocardial infarction; susceptibility to angle-closure glaucoma; tolerance; ventilation and perfusion abnormalities Cautions, further information Tolerance Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 12 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for 8-12 hours (usually overnight) in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate if prescribed a long-acting nitrate with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls).
Contraindications
Aortic stenosis; cardiac tamponade; constrictive pericarditis; hypertrophic cardiomyopathy; hypotensive conditions; hypovolaemia; marked anaemia; mitral stenosis; raised intracranial pressure due to cerebral haemorrhage; raised intracranial pressure due to head trauma; toxic pulmonary oedema
Side effects
Common or very common Arrhythmias; asthenia; cerebral ischaemia; dizziness; drowsiness; flushing; headache; hypotension; nausea; vomiting Uncommon Circulatory collapse; diarrhoea; skin reactions; syncope Side-effects For glyceryl trinitrate Uncommon With parenteral use Cardiac disorder; cyanosis With rectal use Anorectal disorder; anorectal haemorrhage; gastrointestinal discomfort With sublingual use Cyanosis Rare or very rare With parenteral use Methaemoglobinaemia; respiratory disorder; restlessness With sublingual use Methaemoglobinaemia; respiratory disorder; restlessness With topical use Dyspepsia Frequency not known With parenteral use Hyperhidrosis With rectal use Vertigo With sublingual use Tongue blistering With transdermal use Palpitations
Interactions
**Other interactions (4):**
- Concomitant treatment with other vasodilators (e.g.
- The blood pressure lowering effect of these patches will be increased if used together with phosphodiesterase inhibitors (e.g.
- Concurrent administration with Amifostine and acetyl salicylic acid may potentiate the hypotensive effect of the preparation.
- Sapropterine (Tetrahydrobiopterine, BH4) is a cofactor for nitric oxide synthetase.
Pregnancy
Not known to be harmful.
Breast feeding
No information available-manufacturers advise use only if potential benefit outweighs risk.
Hepatic impairment
In general, manufacturers advise caution in severe impairment.
Renal impairment
In general, manufacturers advise caution in severe impairment.
Medicinal forms
Solution,Tablet,Spray,Solution,Ointment,Patch
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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