Usual Adult Dose for Angina Pectoris

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:

• Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
• Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Use: Treatment of angina pectoris in patients who have not responded to sublingual nitroglycerin and beta-blockers.

LINGUAL SPRAY:
1 to 2 sprays (0.4 to 0.8 mg) on or under tongue every 5 minutes as needed, up to 3 sprays in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended

Comments:

• Administer while sitting due to rapid onset.
• Advise patient not to inhale or swallow this medication.

Use: Acute relief of an anginal attack.

SUBLINGUAL TABLET:
0.3 to 0.6 mg sublingually or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended

Comments:

• Administer while sitting down due to rapid onset.
• Advise patient not to chew or swallow this medication.

Use: Acute relief of an anginal attack.

Usual Adult Dose for Angina Pectoris Prophylaxis

LINGUAL SPRAY:
1 to 2 sprays (0.4 to 0.8 mg) on or under tongue 5 to 10 minutes prior to activity that might precipitate an acute attack

Comments:

• Administer while sitting due to rapid onset.
• Advise patient not to inhale or swallow this medication.

SUBLINGUAL TABLET:
0.3 to 0.6 mg sublingually or in the buccal pouch 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack

Comments:

• Administer while sitting due to rapid onset.
• Advise patient not to chew or swallow this medication.

TOPICAL OINTMENT:
1/2 inch (7.5 mg) topically upon rising and 1/2 inch (7.5 mg) 6 hours later; titrate as needed and tolerated

Comments:

• Clinical trial doses have ranged from 1/2 to 2 inches (7.5 to 30 mg) applied to 36 square inches of truncal skin.
• Ointment should be applied to a dry and hairless area of the trunk.

TRANSDERMAL PATCH:
0.2 to 0.4 mg/hr patch applied topically once a day for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr

Comments:

• Patch should be applied to a dry and hairless area of the upper arm or body; rotate application sites to avoid skin irritation.
• Doses between 0.4 and 0.8 mg/hr have shown continued effectiveness for 10 to 12 hours daily for at least 1 month of intermittent administration.

EXTENDED RELEASE CAPSULE:
2.5 to 6 mg orally 3 to 4 times a day; titrate as needed and tolerated

Comments:

• Subjects were titrated up to 26 mg four times a day in one clinical trial.

Usual Adult Dose for Myocardial Infarction

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:

• Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
• Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Use: Control of congestive heart failure in the setting of acute myocardial infarction.

Usual Adult Dose for Hypertension

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:

• Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
• Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Uses:

• Treatment of perioperative hypertension.
• Induction of intraoperative hypotension.

Usual Adult Dose for Anal Fissure and Fistula

RECTAL OINTMENT:
1 inch of ointment (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) intra-anally every 12 hours for up to 3 weeks

Comments:

• A finger covering such as plastic wrap, a disposable surgical glove, or a finger cot should be placed on the finger to apply ointment.
• Insert finger no further than first finger joint and apply around side of anal canal; if unable to insert finger due to pain, apply directly to outside of anus.

Use: Treatment of moderate to severe pain associated with chronic anal fissure.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

Data not available

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice: The manufacturer product information should be consulted.

Storage requirements: The manufacturer product information should be consulted.

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

IV compatibility:

• IV solution: Do not add supplementary medication.

Monitoring: Many cases may require invasive monitoring of pulmonary capillary wedge pressure.

Frequently asked questions

• What is the shelf life of nitroglycerin tablets?
• How do you take GoNitro to treat an angina attack (chest pain)?