Glyceryl trinitrate
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)       :2–3half-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 functionHDF/high flux   :Unknown dialysability. Dose as in normal renal functionCAV/VVHD      :Not dialysed. Dose as in normal renal function IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsAnticoagulants: infusion of GTN reduces anticoagulant effect of heparinsAntidepressants: 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
– 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.
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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