GLYCERYL TRINITRATE = NITROGLYCERIN = TRINITRIN oral

Last updated: August 2021

Therapeutic action

• Vasodilator, antianginal

Indications

• Short-term prophylaxis and treatment of acute angina
• Adjunctive therapy in acute heart failure (acute pulmonary oedema)

Forms and strengths

• 0.5 mg sublingual tablet

Dosage

Short-term prophylaxis of acute angina

• Adult: 0.5 to 1 mg sublingually taken 5 to 10 minutes before a precipitating event (physical exertion, stress, etc.)

Treatment of acute angina

• Adult: 0.5 to 1 mg sublingually, to be repeated 1 to 3 times at 3-4 minute intervals

Adjunctive therapy in acute heart failure (acute pulmonary oedema)

• Adult: 0.5 mg sublingually, to be repeated 1 to 2 times at 5 minute intervals if necessary. The objective is to lower the systolic pressure to 120-150 mmHg and the diastolic pressure to under 110 mmHg.

Do not exceed 3 mg daily.

Duration

• According to clinical response

Contra-indications, adverse effects, precautions

• Do not administer to patients with obstructive cardiomyopathy, hypotension, shock, severe anaemia, intracranial hypertension or neurologic injury.
• May cause:
  • orthostatic hypotension (especially in older patients), headache, nausea, flushing of the face, haemolytic anaemia in patients with G6PD deficiency;
  • severe hypotension with risk of circulatory collapse in the event of overdose.
• Avoid combination or use the lowest effective dose in patients taking another nitrate derivative, a vasodilator, a diuretic or an antihypertensive drug (enhances hypotensive effects), and in older patients. 
• Do not combine with sildenafil or other drugs used for erectile dysfunction (risk of severe hypotension, syncope and acute coronary syndrome).
• Pregnancy: not recommended (safety is not established)
• Breast-feeding: not recommended (safety is not established)

Remarks

• Antianginal effect appears within less than 5 minutes and persists for less than 1 hour.
• Tolerance to nitrates develops with prolonged use and can be overcome by short periods of nitrate withdrawal, and not by dose escalation.
• Sustained-release formulations are used for the long-term management of acute angina and the treatment of heart failure.

Storage