Nitroglycerin
Acute coronary syndrome, Hypertensive emergency with pulmonary edema, Acute decompensated heart failure
Indications
- Acute coronary syndrome
- Hypertensive emergency with pulmonary edema
- Acute decompensated heart failure
Adult dosing
- sublingual: dose: 0.4; unit: mg SL; route: SL; interval: q5min x3; fixed: true; infusion: dose: 5; maxDose: 200; unit: mcg/min; route: IV; interval: titrate q3-5min; fixed: true; high dose: dose: 400; unit: mcg bolus IV; route: IV; fixed: true
Pediatric dosing
- contraindicated: true; reason: Limited pediatric data for emergency use; consult pediatric cardiology
Contraindications
- SBP <90 mmHg
- PDE5 inhibitor use within 24h (sildenafil) or 48h (tadalafil)
- Right ventricular infarction
- Severe aortic stenosis
Clinical pearls
- High-dose NTG boluses (400mcg) effective for acute pulmonary edema
- RV infarction — NTG can cause profound hypotension; avoid
- Ask about Viagra/Cialis before giving — can cause lethal hypotension
- Headache is common side effect — does not require stopping unless severe
Source and review
- AHA/ACC ACS Guidelines 2014; ACEP Clinical Policies. Last reviewed: 2024-11-01