Parenteral Manual

Nitroglycerin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
NITROSTAT®
Classification: 
Vasodilator
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • Severe chronic congestive heart failure                       
  • During coronary artery surgery to reduce myocardial oxygen demand
  • Pulmonary hypertension
  • Hypertensive emergencies occurring perioperatively

 

Reconstitution and Stability: 
  • Available as 200 mcg/mL and 400 mcg/mL glass bottles

  • NTG absorbs to many plastics; use glass infusion bottles or syringe pumps, or a plastic known to be compatible with nitroglycerin (i.e. polyolefin, polyethylene).
    - <40 kg: flush tubing with 5 mL NTG solution
    - >40 kg: Draw up in regular (propylene) syringe and infuse using regular (PVC) tubing.  If glass bottle is hung, flush tubing of glass bottle with 50 mL NTG solution.

 

Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, dextrose-saline combinations, ringer's lactate

- Additive/Above Cassette Compatible: no information

- Y-site Compatible: amiodarone, cisatracurium, dopamine, dobutamine, epinephrine, fentanyl, furosemide, heparin, hydromorphone, morphine, nitroprusside sodium, norepinephrine, KCl, propofol, ranitidine, SMOF Lipid 20%, TPN (amino acids/dextrose), vecuronium

Incompatible: alkaline solutions (ie: sodium bicarbonate), alteplase, caffeine, hydralazine, phenytoin

 

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO
IV Intermittent Infusion

NO
IV Continuous Infusion YES, cardiac monitoring, continuous BP monitoring, CENTRAL LINE preferred
Standard concentration in ER/OR/PICU:  200 mcg/mL and
400 mcg/mL

Click here to access SDC Drug Infusion Sheet

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • IV continuous infusion  Initial: 0.25-0.5 mcg/kg/minute IV
  • Titrate by 0.5-1 mcg/kg/minute IV Q 3-5 minutes PRN
  • Usual dose: 0.5-10 mcg/kg/minute IV
  • Maximum: 20 mcg/kg/minute IV

Adolescent/Adult:

  • IV continuous infusion Initial: 5 mcg/minute IV
  • Increase by 5 mcg/minute IV Q 3-5 minutes up to 20 mcg/minute, then increase by 10 mcg/minute Q 3-5 minutes PRN
  • Maximum: 200 mcg/minute IV
Potential hazards of parenteral administration: 
  • Hypotension, reflex tachycardia, flushing
  • Dizziness, headache, weakness, restlessness
  • Nausea, vomiting
Notes: 
  • Monitor blood pressure, filling pressures, heart rate
  • Note: drug is adsorbed to plastic- monitor patient carefully when IV tubing is changed
  • Contraindicated in hypotension, uncontrolled hypokalemia, constrictive pericarditis
  • Contraindicated with concurrent sildenafil use.  Concurrent use increases vasodilatory effects and results in severe hypotension
  • Onset IV: 1-2 minutes
  • Duration IV: 3-5 minutes
  • Tolerance may develop within 24-48 hours of continuous use

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