HEALTHY LIFESTYLE




Glyceryl trinitrate
Glyceryl trinitrate.JPG

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

    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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