Nitroglycerin (Nitrostat®, Nitrolingual® Spray)

5.29.1 Nitroglycerin (Nitrostat®, Nitrolingual® Spray)

Vasodilator, Nitrate

Nitroglycerin is a direct vasodilator, which acts principally on the venous system although it also produces direct coronary artery vasodilation as a result. There is a decrease in venous return, which decreases the workload on the heart and thus, decreases myocardial oxygen deman. Sublingual nitroglycerin is readily absorbed. Pain relief occurs within one to two minutes and therapeutic effects can last up to 30 minutes.


  • Chest pain or discomfort associated with suspected AMI or Angina Pectoris
  • Pulmonary edema with hypertension


  • Patients increased intracranial pressure, systolic <110 mm Hg, children under 12.
  • Patients who have taken medication for erectile dysfuntion in the past 24 hours.

Tolerance to nitrates easily develops, which necessitates increasing the dosage. Nitroglycerin tablets are inactivated by light, heat, air and moisture. Must be kept in amber glass containers with tight-fitting lids. Do not leave cotton in container. Once opened, nitroglycerin has a shelf life of 3 months. Patients should keep all but a few days' supply of the drug in the refrigerator. Do not shake Nitrolingual spray. Alcohol will accentuate vasodilating and hypotensive effects.


  • CNS: Headache, dizziness, flushing, nausea and vomiting.
  • Cardiovascular: Hypotension, reflex tachycardia.

Adult: 0.4 mg (1 tablet or 1 spary sublingual).
May repeat in 3-5 minutes (no maximum as long as bp is above 110SBP).