nitroglycerin translingual

Action and Spectrum

Actions and spectrum: 

nitroglycerin translingual is a medication that is used to relieve symptoms of angina (chest pain) by relaxing and dilating the blood vessels, thus increasing blood flow to the heart.

nitroglycerin translingual belongs to the class of drugs known as nitrates, which work by releasing nitric oxide in the smooth muscle cells of the blood vessels, resulting in their relaxation. 

nitroglycerin translingual has a wide spectrum of action and can be used to treat angina pectoris caused by coronary artery disease, hypertensive crisis, and pulmonary hypertension. It can be used to relieve the symptoms of heart failure. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Serious 

• Syncope 
• Exfoliative dermatitis 
• Rebound hypertension 
• Hypersensitivity 
• Methemoglobinemia (rare) 
• Prolonged bleeding time 
• Unstable angina 
• Thrombocytopenia 

Common 

• Hypotension 
• Dizziness 
• Blurred vision 
• Nausea/Vomiting 
• Xerostomia 
• Headache 
• Tachycardia 
• Lightheadedness 
• Flushing 
• Nervousness 

Black Box Warning

Black Box Warning: 

nitroglycerin translingual has a black box warning for its potential to cause rebound hypertension and for its potential to cause methemoglobinemia, a rare but serious blood disorder characterized by the presence of abnormal levels of methemoglobin, a form of hemoglobin that cannot bind oxygen efficiently. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

nitroglycerin translingual is contraindicated in patients with a known hypersensitivity to nitroglycerin or any component of the product. It should not be used in patients having severe anemia, closed-angle glaucoma, and hypotension. The use of nitroglycerin translingual is also contraindicated in patients who are taking certain medications, such as riociguat, sildenafil, tadalafil, and vardenafil, due to the potential for severe hypotension.  

Caution: 

• Hypotension: nitroglycerin can cause severe hypotension, especially in patients who are already hypovolemic. It should be used under caution in patients with hypotension. 
• Tolerance: Long-term use of nitroglycerin can lead to tolerance, meaning that the drug becomes less effective over time. Patients may require higher doses or more frequent dosing to achieve the desired effect. 
• Headache: nitroglycerin can cause severe headaches, especially when first starting treatment. Patients should be advised to take acetaminophen or ibuprofen to help relieve headache symptoms. 
• Interaction with PDE5 inhibitors: nitroglycerin should not be used in patients taking PDE5 inhibitors, such as sildenafil, tadalafil, or vardenafil, due to the potential for life-threatening hypotension. 
• Interaction with alcohol: nitroglycerin should not be used with alcohol as it can increase the risk of hypotension. 
• Interaction with other vasodilators: nitroglycerin should not be used with other vasodilators, such as calcium channel blockers or ACE inhibitors, as it can increase the risk of hypotension. 
• Interaction with beta-blockers: nitroglycerin can interact with beta-blockers, leading to decreased efficacy of both drugs

Comorbidities: 

• Hypotension or severe hypovolemia 
• Head injury or increased intracranial pressure 
• Anemia 
• Glaucoma 
• Renal or hepatic dysfunction 
• Thyroid disease 
• Chronic obstructive pulmonary disease (COPD) 
• Coronary artery disease 
• Heart failure 
• Hypertrophic obstructive cardiomyopathy (HOCM) 
• Aortic or mitral stenosis 
• Cardiac tamponade 
• Constrictive pericarditis 
• Arrhythmias 

Pregnancy / Lactation

Pregnancy consideration: US FDA pregnancy category: C 

Lactation: It is not known whether nitroglycerin translingual passes into breast milk  

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: There is no evidence of risk to the fetus found in animal reproduction studies and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for an effect in humans, care must be taken for potential risks in pregnant women. 
• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite potential risks may be used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits These category drugs should be prohibited for pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

nitroglycerin translingual is a vasodilator drug that works by relaxing the smooth muscles in blood vessels, resulting in their dilation. nitroglycerin is rapidly metabolized in the liver to release nitric oxide, which activates the enzyme guanylate cyclase. This leads to an increase in cyclic guanosine monophosphate (cGMP), causing vasodilation and a decrease in blood pressure. nitroglycerin also has a direct dilatory effect on coronary arteries, increasing blood flow to the heart.  

Pharmacodynamics: 

nitroglycerin translingual is a potent vasodilator that works by relaxing the smooth muscle in blood vessels, especially those in the veins. This results in a decrease in venous return to the heart, which reduces the workload on the heart and improves blood flow to the heart muscle. nitroglycerin translingual also dilates the coronary arteries, which improves oxygen delivery and blood flow to the heart muscle. Additionally, nitroglycerin translingual can dilate the arteries in the systemic circulation, which can lead to a decrease in blood pressure. The onset of action of nitroglycerin translingual is usually within 1-3 minutes, and the duration of action is typically 20-30 minutes.  

Pharmacokinetics: 

Absorption 

nitroglycerin is rapidly absorbed through the sublingual mucosa, with onset of action typically occurring within 1 to 3 minutes after administration. The bioavailability of nitroglycerin sublingual is about 70%, as it undergoes first-pass metabolism in the liver. 

Distribution 

nitroglycerin is widely distributed throughout the body. It is bound to plasma proteins to a limited extent. 

Metabolism 

nitroglycerin undergoes extensive first-pass metabolism in the liver to form the active metabolite, nitric oxide (NO), which is responsible for the drug’s vasodilatory effects. The enzyme responsible for this metabolism is aldehyde dehydrogenase (ALDH). nitroglycerin also undergoes denitration, forming the inactive metabolites glycerol dinitrate and glycerol mononitrate. 

Elimination and excretion 

The half-life of nitroglycerin is short, about 1-4 minutes, and it is rapidly metabolized and eliminated. The metabolites get excreted in the urine. 

Adminstartion

Administration: 

nitroglycerin translingual is a medication that is administered sublingually. The medication can br taken in the form of a spray or tablet. When administering the spray, the patient should hold the spray bottle upright and place the nozzle under the tongue.

The patient should then press down firmly on the pump to release the spray. The patient should keep their mouth closed and avoid swallowing for a few seconds to allow the medication to be absorbed. The recommended dose is usually one or two sprays. 

When administering the tablet, the patient should place the tablet below the tongue and allow it to dissolve completely. The patient should not swallow the tablet or chew it. The recommended dose is usually one tablet. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: nitroglycerin translingual 

Pronounced: “Nye-troh-GLIS-er-in”  

Why do we use nitroglycerin translingual? 

nitroglycerin translingual is primarily used to relieve chest pain or angina due to coronary artery disease. It works by dilating blood vessels, increasing blood flow to the heart muscle, and reducing the workload on the heart. It may also be used to treat acute heart failure, acute pulmonary edema, and hypertensive crisis.

Additionally, it may be used in combination with other medications for the management of heart failure or high blood pressure. nitroglycerin translingual is usually used as a short-acting treatment for acute symptoms and is not recommended for long-term use.