Glyceryl Tri nitrate

Details About Generic Salt ::  Glyceryl Tri nitrate 

Main Medicine Class:: #N/A   Sub Medicine Class ::  #N/A

4C. ANTI-ANGINALS in 4. CARDIOVASCULAR SYSTEM
GLYCERYL TRI NITRATE
VASODILATOR | ANTI-ANGINAL
also comes under 4A. Drugs for Cardiac Failure & Shock in 4. Cardiovascular System
PK: A: Rapid D: Extensive M: Hepatic

Indications & Dose: ANGINA ATTACK SL Adult 0.3-0.6mg, repeat q5min for 15 min or 1-2 translingual sprays (0.4mg/spray), repeat q5min for 15 min | Long-term therapy/Prophylactic therapy BCL Adult ER tab: 1mg q5h, may increase dosage & frequency as needed | ANGINA PECTORIS Long-term therapy/Prophylactic therapy PO Adult ER tab: 2.5-9mg q8-12h or ER capsule: 1.3-6.5mg q8-12h | IV Adult 5µg/min, increase by 5µg/min q3-5min to 20µg/min, if no response may increase by 10-20µg/min q3-5min, max 400µg/min (same dose is used for prophylaxis) | TD Adult Patch: Initially 0.2-0.4mg/h, titrate to 0.4-0.8mg/h, tolerance is minimized by using a patch-on period of 12-14h & patch-off period of 10-12h (same dose is used for prophylaxis) | TP Adult Ointment (2%): 1/2” upon rising & 1/2” 6h later, if needed, the dose may be doubled to 1” & subsequently doubled again to 2” if response is inadequate, max 2doses/day (include a nitrate free-interval ~10-12h/day)(same dose is used for prophylaxis) | HEART FAILURE IV Adult 12.5-25µg, then continuous Inf 10-20µg/min q5-10min, increase by 5-10µg/min q5-10min as needed, max 200µg/minAssociated with acute MI | Adjunct therapy IV Adult 5µg/min, increase by 5µg/min q3-5min up to 20µg/min, then increase by 10-20µg/min q3-5min (dosage based on hemodynamic parameters) | HYPERTENSION DURING SURGERY IV Adult 5µg/min, increase by 5µg/min q3-5min up to 20µg/min, then increase by 10-20µg/min q3-5min (dosage based on hemodynamic parameters) | INDUCTION OF INTRAOPERATIVE HYPOTENSION IV Adult 5µg/min, increase by 5µg/min q3-5min to 20µg/min, if no response may increase by 10-20µg/min q3-5min, max 400µg/min | PHLEBITIS & EXTRAVASATION SECONDARY TO VENOUS CANNULATIONN Prophylactic therapy TD Adult 1 patch (5mg) is applied distal to the IV site, replace patch to different skin site daily/after 3-4 days (based on patch) & continue till Inf is given

Contra: Hypersensitivity, concurrent PDE-5 inhibitors therapy, increased intracranial pressure, severe anemia, inadequate cerebral circulation, constrictive pericarditis, restrictive cardiomyopathy, severe hypotension, hypovolemia, marked anemia, HF due to obstruction, raised intracranial pressure, long-acting agents in acute MI/acute HF, extreme bradycardia, right ventricular MI, hypertrophic cardiomyopathy with outflow tract obstruction

Precautions: Severe renal/hepatic impairment, hypothyroidism, malnutrition, hypothermia, metalcontaining transdermal patches should be removed before cardioversion/diathermy, moderate hypotension, inferior wall MI & suspected right ventricular involvement, appropriate dosing is needed due to development of tolerance, angle-closure glaucoma

ADR: Serious: Anaphylactoid reaction, cardiovascular collapse, hypotension, postural hypotension, crescendo angina, exfoliative dermatitis, methemoglobinemia, rebound HTN, flushing, peripheral edema, syncope, tachycardia, Others: headache, dizziness, lightheadedness, nausea, vomiting, xerostomia, paresthesia, pharyngitis, rhinitis, diaphoresis, restlessness

DDI: Serious Ergot derivatives antagonizes anti-anginal effects, CCBs enhances hypotensive effects, Phosphodiesterase type-5 inhibitors potentiates hypotensive effects of nitrates, Alteplase reduces thrombolytic effect of drug

Monitor: BP, HR

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