Nitroglycerin 2% Topical

Indications

Nitroglycerin 2% Topical is used for: Angina Pectoris, Congestive Heart Failure

Adult Dose

Topical/Cutaneous Stable angina Adult: As 2% oint: Apply 0.5-2 inches on a convenient area of the skin bid or 3-4 hrly if necessary; cover the area after application. Congestive Heart Failure 1.5 inches, increase by 0.5-1 inch up to 4 inches, q4hr

Child Dose

Safety and efficacy not established

Renal Dose

Administration

Contra Indications

Hypersensitivity to organic nitrates Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life Riociguat; coadministration may cause hypotension Narrow angle glaucoma (controversial: may not be clinically significant) Severe anemia

Precautions

Alcohol use, incr ICP (head trauma, cerebral hemorrhage-potential contraindication), hyperthyroidism, hypertrophic cardiomyopathy, increase IOP, hypotension, volume depletion, low systolic BP Do not change brands unintentionally as not all are bioequivalent Treat drug-induced headache with aspirin or acetaminophen Provide nitrate-free interval (10-12 hr or overnight) to avoid development of tolerance Discontinue if blurred vision develops Do not apply with fingers; do not rub or massage Lactation: not known whether the drug crosses into breast milk, use caution

Pregnancy-Lactation

Interactions

Adverse Effects

Side effects of Nitroglycerin 2% Topical : Orthostatic hypotension, peripheral oedema, bradycardia, tachycardia flushing, hypotension, syncope, dizziness, headache, light-headedness, nausea, vomiting, xerostomia, weakness, paraesthesia, diaphoresis, dyspnoea, rhinitis, pharyngitis, allergic reaction.

Mechanism of Action

Organic nitrate which causes systemic venodilation, decreasing preload Cellular mechanism: nitrate enters vascular smooth muscle and converted to nitric oxide (NO) leading to activation of cGMP & vasodilation Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial O2 demand Also improves coronary collateral circulation Lower BP, increase HR, occasional paradoxical bradycardia