Brands, Medical Use, Clinical Data
Drug Category
- Tocolytic Agents
- Vasodilator Agents
- Nitrates and Nitrites
Dosage Forms
- Tablet (extended-release)
- Tablet (slow-release)
- Ointment
- Lingual aerosol spray
- Transdermal delivery system
Brands / Synonyms
Adesitrin; Aldonitrin; Angibid; Anginine; Angiolingual; Angiplex; Angised; Anglix; Angonist; Angorin; Anogesic; Aquo-Trimitrosan; Aquo-Trinitrosan; Blasting Gelatin; Blasting Oil; Buccard; Cardabid; Cardamist; Cardinit; Cardiodisco; Cascade; Chitamite; Colenitral; Corangil; Corangin Nitrokapseln; Cordipatch; Corditrine; Coro-Nitro; Dauxona; Deponit; Deponit 5; Deponit TTS 10; Deponit TTS 5; Deponit-5; Diafusor; Discotrine; Epinitril; Explosive Gum; Gepan Nitroglicerin; Gilucor; Gilucor Nitro; Gilustenon; Glonoin; Glonoine Oil; Glycerin Trinitrate; Glycerintrinitrate [Czech]; Glycerol Trinitrate; Glycerol, Nitric Acid Triester; Glyceroltrinitraat; Glyceroltrinitraat [Dutch]; Glyceryl; Glyceryl Nitrate; Glyceryl Trinitrate; Glycerylnitrat; Glytrin; GTN; Gtn-Pohl; Hercol 2; Hercol 2x; Hercon 2; Hercon 2x; Hercosplit WR; Herwicard; Herzer; Klavikordal; Lenitral; Lentonitrina; Mi-Trates; Millisrol; Minitram; Minitran; Mionitrat; Myocon; Myoglycerin; Myovin; Natispray; Neos Nitro Opt; NG; Niglin; Niglycon; Niong; Niong Retard; Nirmin; Nit-Ret; Nitora; Nitradisc; Nitradisc Pad; Nitradisc Tts; Nitran; Nitrek; Nitric Acid Triester of Glycerol; Nitric Acid Triester of Gylcerol; Nitriderm; Nitriderm Tts; Nitrin; Nitrine; Nitrine-Tdc; Nitro Dur TTS; Nitro Mack; Nitro Mack Retard; Nitro Rorer; Nitro-Bid; Nitro-Dur; Nitro-Dur 10; Nitro-Dur 5; Nitro-Gesanit Retard; Nitro-Lent; Nitro-Mack Retard; Nitro-Par; Nitro-Pflaster; Nitro-Prn; Nitro-Span; Nitro-Time; Nitroard; Nitrobaat; Nitrobid; Nitrobid Oint; Nitrobukal; Nitrocapt.D.; Nitrocerin; Nitrocine; Nitrocine 5; Nitroclyn; Nitrocontin; Nitrocontin Continus; Nitrocor; Nitrocot; Nitroderm; Nitroderm TTS; Nitroderm TTS Ext; Nitroderm TTS-5; Nitrodisc; Nitrodyl; Nitrodyl TTS; Nitrogard; Nitrogard-SR; Nitroglicerina; Nitroglicerina [Italian]; Nitroglicerina [Spanish]; Nitrogliceryna; Nitrogliceryna [Polish]; Nitroglin; Nitroglycerin; Nitroglycerin Dynamite; Nitroglycerin in Dextrose 5%; Nitroglycerin Mixture With; Nitroglycerin [Usan:Jan]; Nitroglycerine; Nitroglycerol; Nitroglyn; Nitrol; Nitrol Creme; Nitrolan; Nitrolande; Nitrolar; Nitroletten; Nitrolingual; Nitrolingual Spray; Nitrolowe; Nitromel; Nitromex; Nitromist; Nitronal; Nitronet; Nitrong; Nitrorectal; Nitroretard; Nitrosigma; Nitrostabilin; Nitrostat; Nitrozell Retard; NTG; NTS; Nysconitrine; Orient Oil Yellow GG; Percutol; Perglottal; Perlinganit; Petrol Yellow WT; Propanetriol Trinitrate; Rcra Waste Number P081; Reminitrol; S.N.G; S.N.G.; SNG; Solution Glyceryl Trinitrate; Soup; Spirit of Glonoin; Spirit of Glyceryl Trinitrate; Spirit of Trinitroglycerin; Spirits of Nitroglycerin; Susadrin; Suscard; Sustac; Sustonit; Sutonit; Temponitrin; TNG; Transderm-Nitro; Transderm-Nitro TTS; Transiderm-Nitro; Tridil; Trinalgon; Trinitrin; Trinitrin Tablets; Trinitroglycerin; Trinitroglycerol; Trinitrol; Trinitrosan; Unigel; Vasoglyn
Indications
For the prevention of angina
Pharmacology
Nitroglycerin, an organic nitrate, is available in many forms as a vasodilator. Nitroglycerin is used in the treatement of angina pectoris and perioperative hypertension, to produce controlled hypotension during surgical procedures, to treat hypertensive emergencies, and to treat congestive heart failure associated with myocardial infarction.
Mechanism of Action
Similar to other nitrites and organic nitrates, nitroglycerin is converted to nitric oxide (NO), an active intermediate compound which activates the enzyme guanylate cyclase. This stimulates the synthesis of cyclic guanosine 3',5'-monophosphate (cGMP) which then activates a series of protein kinase-dependent phosphorylations in the smooth muscle cells, eventually resulting in the dephosphorylation of the myosin light chain of the smooth muscle fiber. The subsequent release of calcium ions results in the relaxation of the smooth muscle cells and vasodilation.
Absorption
Not Available
Toxicity
Increased intracranial pressure, with any or all of persistent throbbing headache, confusion, and moderate fever; Vertigo; Palpitations; Visual disturbances; Nausea and vomiting (possibly with colic and even bloody diarrhea); Syncope (especially in the upright posture); Air hunger and dyspnea, later followed by reduced ventilatory effort; Diaphoresis, with the skin either flushed or cold and clammy; Heart block and bradycardia; Paralysis; Coma; Seizures; Death.
Biotrnasformation / Drug Metabolism
Hepatic, cytochrome P450 (P450) is a key enzyme of organic nitrate biotransformation
Contraindications
CONTRAINDICATIONS
Use of Transderm-Nitro (nitroglycerin) transdermal system is contraindicated in patients
using ViagraŽ (sildenafil) because sildenafil may amplify the vasodilatory effects of
Transderm-Nitro resulting in severe hypotension.
Allergic reactions to organic nitrates are extremely rare, but they do occur. Nitroglycerin
is contraindicated in patients who are allergic to it. Allergy to the adhesives used in
nitroglycerin patches has also been reported, and it similarly constitutes a contraindication
to the use of this product.
Drug Interactions
DRUG INTERACTIONS
The vasodilating effects of nitroglycerin may be additive with those of other
vasodilators. Alcohol, in particular, has been found to exhibit additive
effects of this variety.
Marked symptomatic orthostatic hypotension has been reported when calcium
channel blockers and organic nitrates were used in combination. Dose
adjustments of either class of agents may be necessary.
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