Glyceryl trinitrate

CLINICAL USE

Vasodilator:Treatment and prophylaxis of angina, left ventricular failure, hypertension during surgeryAnal fissures

DOSE IN NORMAL RENAL FUNCTION

S/L tablets: 0.3–1 mg as required Buccal: 2–10 mg 3 times daily or when requiredOral dose depends on preparation used Patches: 5–15 mg every 24 hours

IV infusion

: 10–200 mcg/minute; up to 400 mcg/min may be required during surgeryAnal fissures: 0.2–0.8% ointment every 12 hours

PHARMACOKINETICS

Molecular weight :227.1

%Protein binding :30–60

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) :2–3

half-life – normal/ESRD (hrs) :1–4 minutes/unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anticoagulants: infusion of GTN reduces anticoagulant effect of heparins

Antidepressants: tricyclics may reduce effect of sublingual tablets due to dry mouthAntimuscarinics: may reduce effect of sublingual tablets due to dry mouthSildenafil: hypotensive effect significantly enhanced – avoid concomitant useTadalafil: hypotensive effect significantly enhanced – avoid concomitant use

Vardenafil: hypotensive effect significantly enhanced – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

IV, buccal, S/L, oral, topical

Rate of Administration

10–400 mcg/minute (depends on response)

Comments

Compatible with sodium chloride 0.9% and glucose 5%Incompatible with polyvinylchloride bags

OTHER INFORMATION

Tolerance may develop; may be minimised by having nitrate-‘free’ periodsIV infusions contain propylene glycol which can cause lactic acidosis – restrict to using for no more than 3 consecutive days.

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