GLYCERYL TRINITRATE = NITROGLYCERIN = TRINITRIN oral

Last updated: August 2021

Prescription under medical supervision


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: below 25 °C, preferably in airtight glass container -