nitroglycerin topical

Action and Spectrum

Actions and Spectrum:  

Action:

When treating Congestive Heart Failure, healthcare providers typically prescribe a starting medication dosage of 1.5 inches, which can be increased by 0.5-1 inch up to a maximum of 4 inches. The medication should be administered every four hours. 

Spectrum:

The use of nitroglycerin topical is limited to the treatment of certain conditions, including angina and heart failure. It is not adequate for the treatment of other conditions. nitroglycerin topical is primarily used for the relief of angina symptoms, such as chest pain and discomfort, by increasing blood flow to the heart. In addition, it is utilized for the treatment of heart failure as it helps decrease the burden on the heart and enhance blood circulation to the organs. 

Drug Interaction

Adverse Reaction

Frequency not defined  

Dizziness 

Headache 

Flushing 

Nervousness 

Hypotension 

Tachycardia 

Topical allergic reactions 

Blurred vision 

Nausea/vomiting 

Xerostomia 

Serious 

Syncope 

Methemoglobinemia (rare) 

Prolonged bleeding time 

Exfoliative dermatitis 

Rebound hypertension 

Unstable angina 

Black Box Warning

Black Box Warning:  

nitroglycerin topical can cause serious methaemoglobinaemia, a blood disorder that reduces the amount of oxygen that the blood can carry. This can lead to serious and potentially life-threatening complications, including: 

Headache 

Shortness of breath 

Rapid heart rate 

Dizziness  

Loss of consciousness 

Seizures 

Contraindication / Caution

Contraindication/Caution:  

Allergy: If you have a known allergy or hypersensitivity to nitroglycerin or any of the other ingredients in the medication, you should not use nitroglycerin topical.  

Severe anemia: nitroglycerin can increase the risk of developing methemoglobinemia, a condition that reduces the amount of oxygen that the blood can carry. It is therefore not recommended for people with severe anemia.  

Head injury: nitroglycerin can increase intracranial pressure, which can be dangerous for people with head injuries. Therefore, nitroglycerin topical should not be used in such cases.  

Low blood pressure: nitroglycerin has the potential to cause a rapid decrease in blood pressure, which can pose a risk for individuals with pre-existing low blood pressure. Therefore, it is not advisable for people with a systolic blood pressure below 90 mmHg to take nitroglycerin.  

Use of PDE-5 inhibitors: nitroglycerin should not be used with phosphodiesterase-5 (PDE-5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Taking a mixture of these drugs can result in an abrupt decrease in blood pressure, posing a significant risk to one’s life.  

Glaucoma: nitroglycerin can increase intraocular pressure and worsen glaucoma. Therefore, nitroglycerin topical should not be used in people with glaucoma.  

Recent heart attack: nitroglycerin topical is not recommended for people who have recently had a heart attack. 

Pregnancy / Lactation

Pregnancy warnings:     

Pregnancy category: N/A 

Lactation: Excreted into human milk is unknown 

Pregnancy Categories:         

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester. 

Category B: There were a lack of studies on pregnant women and no evidence of risk to the fetus in animal experiments.   

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology: nitroglycerin is classified as an organic nitrate medication and is commonly prescribed for the treatment of angina, a type of chest pain that arises due to inadequate blood flow to the heart muscle.  

Pharmacodynamics: 

The pharmacodynamics mechanism of nitroglycerin topical involves its conversion into nitric oxide, which leads to vasodilation and increased blood flow to the affected area.  

MOA:  

The mechanism of action of nitroglycerin involves the conversion of nitroglycerin to nitric oxide (NO) in the body. Nitric oxide is a potent vasodilator that relaxes the smooth muscles in the blood vessels and increases blood flow. Nitric oxide also activates the enzyme guanylate cyclase, which produces cyclic guanosine monophosphate (cGMP), a second messenger that promotes smooth muscle relaxation.  

Pharmacokinetics:  

Absorption: 

The patch containing nitroglycerin works by gradually releasing the medication, which is then absorbed through the skin and into the bloodstream. Various factors, such as the patch’s size, the area where it is applied, and the skin’s condition, may affect the rate at which the medication is absorbed. 

Distribution:  

nitroglycerin, after entering the bloodstream, gets distributed to various parts of the body, including the heart and blood vessels. 

Metabolism: 

nitroglycerin is metabolized by enzymes in the liver and other tissues, forming metabolites such as nitrite and nitric oxide, which are responsible for its pharmacological effects.  

Excretion and elimination: 

 The metabolites of nitroglycerin are excreted primarily in the urine. 

Adminstartion

Administration:   

Apply a small amount of the medication to the affected area, usually on the chest or the upper arm. Use the applicator provided with the medication or a clean, dry finger to apply the medication.  

Rub the medication in gently until it is fully absorbed into the skin. Do not apply the medication to broken or irritated skin.  

If you are using nitroglycerin topical to prevent angina, apply the medication at the same time every day.  

If you experience chest pain or discomfort after applying the medication, sit or lie down and take a nitroglycerin tablet as directed by your doctor.  

Do not use nitroglycerin topical more often than prescribed by your doctor, as this can increase the risk of side effects. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: nitroglycerine topical 

Why do we use nitroglycerine topical?   

nitroglycerin topical is a medication that is used to treat episodes of angina, a type of chest pain caused by the narrowing of the blood vessels that supply the heart with oxygen-rich blood. nitroglycerin works by dilating the blood vessels and increasing blood flow to the heart, which helps to relieve the symptoms of angina. 

nitroglycerin topical is usually applied as a patch or ointment to the skin. The medication is absorbed through the skin and into the bloodstream, where it can begin to work within a few minutes.  

In addition to treating angina, nitroglycerin topical can also be used to treat anal fissures, a condition in which there are small tears in the tissue that lines the anus. In this case, the medication works by relaxing the muscles around the anus, which helps to reduce pain and promote healing.