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NitroMist
nitroglycerin
Adult Dosing .
Dosage forms: SPRAY: 0.4 mg per actuation
angina, acute
- [1-2 actuations SL q5min prn]
- Max: 3 actuations w/in 15min
angina prophylaxis
- [1-2 actuations SL x1]
- Start: 5-10min before strenuous activity
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- anemia, severe
- ICP incr.
- circulatory collapse
- shock
- caution: hypotension
- caution: hypovolemia
- caution: MI, acute
- caution: CHF
- caution: cardiomyopathy, hypertrophic
Drug Interactions .
Overview
nitroglycerin
nitrate
- alters gallbladder contraction/motility
- methemoglobinemia
- vasodilator agent
- if SL nitroglycerin tab use, caution advised w/ anticholinergic drugs, tricyclic antidepressants, other drugs that may cause xerostomia; combo may delay vasodilator onset, decr. nitroglycerin peak levels, efficacy; absorption decreased, xerostomia may alter dissolution of SL tab
Contraindicated
- avanafil
- lidocaine topical
- prilocaine topical
- riociguat
- sildenafil
- tadalafil
- vardenafil
Avoid/Use Alternative
- aldesleukin
- captopril
- dihydroergotamine
- ergotamine
- ethanol
- lofexidine
- methylergonovine
- rosiglitazone
Monitor/Modify Tx
- acebutolol
- alfentanil
- alfuzosin
- aliskiren
- amantadine
- amifostine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- apomorphine
- apraclonidine ophthalmic
- aripiprazole
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- articaine
- asenapine
- aspirin
- atenolol
- azilsartan medoxomil
- benazepril
- berberine
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bexagliflozin
- bisoprolol
- bortezomib
- brexpiprazole
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- bumetanide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- butorphanol
- cabergoline
- canagliflozin
- candesartan cilexetil
- cannabis
- cariprazine
- carteolol ophthalmic
- carvedilol
- chloroprocaine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cilostazol
- clevidipine
- clofarabine
- clomipramine
- clonidine
- clozapine
- codeine
- coenzyme Q-10
- dapagliflozin
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- dihydrocodeine
- diltiazem
- dinutuximab
- dipyridamole
- doxazosin
- doxepin
- dronabinol
- duloxetine
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- entrectinib
- eplerenone
- epoprostenol
- ertugliflozin
- esmolol
- ethacrynic acid
- felodipine
- fenoldopam
- fentanyl
- ferumoxytol
- flaxseed
- flibanserin
- fluphenazine
- flutamide
- fosinopril
- furosemide
- garlic
- gilteritinib
- guanfacine
- haloperidol
- heparin
- hydralazine
- hydrochlorothiazide
- hydrocodone
- hydromorphone
- iloperidone
- iloprost
- iloprost inhaled
- imipramine
- indapamide
- iobenguane I 131
- irbesartan
- iron sucrose
- isocarboxazid
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- labetalol
- levobunolol ophthalmic
- levodopa
- levorphanol
- lidocaine
- lisinopril
- losartan
- loxapine
- lubiprostone
- lumateperone
- lurasidone
- magnesium sulfate
- maraviroc
- meperidine
- mepivacaine
- methadone
- methohexital
- methyldopa
- methylene blue injection
- metolazone
- metoprolol
- midazolam
- milrinone
- minoxidil
- mirtazapine
- moexipril
- molindone
- morphine
- nadolol
- nalbuphine
- nattokinase
- nebivolol
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nimodipine
- nisoldipine
- nitric oxide
- nitrite
- nitroprusside
- nortriptyline
- obinutuzumab
- olanzapine
- oliceridine
- olmesartan medoxomil
- opicapone
- opium
- oxazepam
- oxycodone
- oxymorphone
- paliperidone
- pentamidine
- pentazocine
- pentobarbital
- perindopril
- perphenazine
- phenelzine
- phenobarbital
- phenoxybenzamine
- phentolamine
- pindolol
- pramipexole
- prazosin
- procarbazine
- prochlorperazine
- promethazine
- propofol
- propranolol
- protriptyline
- quetiapine
- quinapril
- ramipril
- rasagiline
- remifentanil
- remimazolam
- risperidone
- ropinirole
- ropivacaine
- rotigotine transdermal
- sacubitril
- safinamide
- sapropterin
- selegiline
- selegiline transdermal
- sevoflurane
- silodosin
- sincalide
- sodium ferric gluconate complex
- sotagliflozin
- sotalol
- sparsentan
- spironolactone
- sufentanil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telmisartan
- terazosin
- thalidomide
- thioridazine
- thiothixene
- timolol
- timolol ophthalmic
- tizanidine
- tolcapone
- torsemide
- tramadol
- trandolapril
- tranylcypromine
- trazodone
- treprostinil
- triamterene
- trifluoperazine
- trimipramine
- valsartan
- vericiguat
- vosoritide
- yohimbe
- ziprasidone
Caution Advised
- alteplase
- benzocaine topical
- butamben
- dapsone
- dapsone topical
- metoclopramide
- nitrofurantoin
- primaquine
- procaine
- rasburicase
- resorcinol topical
- sulfadiazine
- sulfamethoxazole
- sulfasalazine
- tafenoquine
- tetracaine
Adverse Reactions .
Serious Reactions
- hypotension, severe
- syncope
- anaphylactoid rxn
- exfoliative dermatitis
- methemoglobinemia
- nitrate tolerance (excessive or continuous use)
Common Reactions
- headache
- dizziness
- paresthesia
- weakness
- flushing
- rash
- hypotension, orthostatic
Safety/Monitoring .
Monitoring Parameters
BP
Look/Sound-Alike Drug Names
nitroglycerin confused with: glycerin; Neo-Synephrine; nicotine; nitrofurantoin; nitroprusside; nystatin
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; risk of fetal harm not expected based on limited human data; no known risk of fetal harm based on animal data w/ topical form at up to 240 mg/kg/day
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding, esp. in infants <6 mo; inadequate human data available, though possible risk of infant methemoglobinemia; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver primarily, erythrocytes, vascular walls; CYP450: unknown; Info: active metabolites
Excretion: urine; Half-life: 2-3min (parent drug), 40min (active metabolites)
Subclass: Antianginals ; Vasodilators/Nitrates
Mechanism of Action
stimulates cGMP production, resulting in vascular smooth muscle relaxation
Formulary .
No Formulary Selected
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