Nitroglycerin Injection, USP is indicated for treatment of perioperative hypertension; for control of congestive heart failure in the setting of acute myocardial infarction; for treatment of angina pectoris in patients who have not responded to sublingual nitroglycerin and ?-blockers; and for induction of intraoperative hypotension.

---

Hypertensive disease -- Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.

Congestive heart failure -- complication of heart diseases; defective cardiac filling and/or impaired contraction and emptying, resulting in the heart's inability to pump a sufficient amount of blood to meet the needs of the body tissues or to be able to do so only with an elevated filling pressure.

Acute myocardial infarction --

Angina Pectoris -- The symptom of paroxysmal pain consequent to MYOCARDIAL ISCHEMIA usually of distinctive character, location and radiation. It is thought to be provoked by a transient stressful situation during which the oxygen requirements of the MYOCARDIUM exceed that supplied by the CORONARY CIRCULATION.

Allergic reactions to organic nitrates are extremely rare, but they do occur.

Nitroglycerin Injection is contraindicated in patients who are allergic to it.In patients with pericardial tamponade, restrictive cardiomyopathy, or constrictive pericarditis, cardiac output is dependent upon venous return.

Intravenous nitroglycerin is contraindicated in patients with these conditions.

---

Allergic Reaction --

Cardiac Tamponade -- Compression of the heart by accumulated fluid (PERICARDIAL EFFUSION) or blood (HEMOPERICARDIUM) in the PERICARDIUM surrounding the heart. The affected cardiac functions and CARDIAC OUTPUT can range from minimal to total hemodynamic collapse.

Restrictive cardiomyopathy -- A form of CARDIAC MUSCLE disease in which the ventricular walls are excessively rigid, impeding ventricular filling. It is marked by reduced diastolic volume of either or both ventricles but normal or nearly normal systolic function. It may be idiopathic or associated with other diseases (ENDOMYOCARDIAL FIBROSIS or AMYLOIDOSIS) causing interstitial fibrosis.

Constrictive pericarditis -- Inflammation of the PERICARDIUM that is characterized by the fibrous scarring and adhesion of both serous layers, the VISCERAL PERICARDIUM and the PARIETAL PERICARDIUM leading to the loss of pericardial cavity. The thickened pericardium severely restricts cardiac filling. Clinical signs include FATIGUE, muscle wasting, and WEIGHT LOSS.

Amplification of the vasodilatory effects of nitroglycerin by sildenafil can result in severe hypotension.

The time course and dose dependence of this interaction have not been studied. Appropriate supportive care has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with volume expansion.Nitroglycerin readily migrates into many plastics, including the polyvinyl-chloride (PVC) plastics commonly used for intravenous administration sets.

Nitroglycerin absorption by PVC tubing is increased when the tubing is long, the flow rates are low, and the nitroglycerin concentration of the solution is high.

The delivered fraction of the solution’s original nitroglycerin content has been 20-60% in published studies using PVC tubing; the fraction varies with time during a single infusion, and no simple correction factor can be used.

PVC tubing has been used in most published studies of intravenous nitroglycerin, but the reported doses have been calculated by simply multiplying the flow rate of the solution by the solution’s original concentration of nitroglycerin.

The actual doses delivered have been less, sometimes much less, than those reported.

Some in-line intravenous filters also absorb nitroglycerin; these filters should be avoided.Because of the absorption problem, Hospira, Inc.

non-PVC infusion tubing was developed to minimize the loss of nitroglycerin.

Hospira, Inc.

Nitroglycerin I.V.

Pump Set or similar infusion sets are recommended for infusions of nitroglycerin (see DOSAGE AND ADMINISTRATION).DOSING INSTRUCTIONS MUST BE FOLLOWED WITH CARE.

WHEN THE APPROPRIATE INFUSION SETS ARE USED, THE CALCULATED DOSE WILL BE DELIVERED TO THE PATIENT, BECAUSE THE LOSS OF NITROGLYCERIN INJECTION SEEN WITH STANDARD PVC TUBING WILL BE AVOIDED.

THE DOSAGES REPORTED IN PUBLISHED STUDIES UTILIZED GENERAL-USE PVC ADMINISTRATION SETS, AND RECOMMENDED DOSES BASED ON THIS EXPERIENCE WILL BE TOO HIGH IF THE LOW-ABSORBING INFUSION SETS ARE USED.

The following US Branded drugs contain Nitroglycerin

---

NITROMIST -- NOVADEL PHARMA INC

NITROLINGUAL -- POHL BOSKAMP

MINITRAN -- GRACEWAY PHARMACEUTICALS LLC

NITRO-DUR -- KEY PHARMACEUTICALS INC SUB SCHERING PLOUGH CORP

TRANSDERM-NITRO -- NOVARTIS PHARMACEUTICALS CORP

NITRO IV -- G POHL BOSKAMP GMBH AND CO

NITRO-BID -- SANOFI AVENTIS US LLC

NITROGLYCERIN IN DEXTROSE 5% -- BAXTER HEALTHCARE CORP

NITROGLYCERIN IN DEXTROSE 5% -- HOSPIRA INC

NITROL -- RORER PHARMACEUTICAL CORP SUB RORER GROUP

NITRONAL -- G POHL BOSKAMP GMBH AND CO

NITROSTAT -- PARKE DAVIS DIV WARNER LAMBERT CO

TRIDIL -- HOSPIRA INC

NITROLINGUAL PUMPSPRAY -- POHL BOSKAMP

NITROSTAT -- PFIZER PHARMACEUTICALS LTD