Nitroglycerin – action, purpose, dosage, contraindications, substitutes

Proven content

Nitroglycerin is an organic chemical compound that is found in many medications used to treat cardiovascular disease. It contributes to the expansion of blood vessels and has a positive effect on the work of smooth muscles.

Nitroglycerin – history

The beginning of nitroglycerin is in 1847, when the Italian chemistry professor Ascanio Sobrero obtained it by nitrating glycerin with a mixture of nitric and sulfuric acids. At first, this substance was known only for its explosive properties (it was then called pyroglycerin). Nitroglycerin, however, was a very problematic substance to use because it was extremely sensitive to slight mechanical stimuli and even when there was local overheating, it resulted in an uncontrolled explosion. For this reason, nitroglycerin has been the source of many accidents.

With time, the problem of the unstable substance was solved, and it was done by the Swedish chemist Alfred Nobel in 1866, when he soaked nitroglycerin with silica, as a result of which dynamite, popular today, was created (in 1867 it was patented and spread all over the world). Over time, nitroglycerin began to be used in medicine. We owe this to an English physician named William Murrell, who in 1879 discovered the anti-anginal effects of an oral nitroglycerin solution. In this way, nitroglycerin quickly became the most popular medication prescribed by doctors for heart problems.

With time, in the XNUMXth century, subsequent research on the use of nitroglycerin derivatives in medicine allowed for the production of new, safer and with a broader spectrum of action medical preparations used in the treatment of coronary artery disease. Although many drugs have been developed for these diseases, nitroglycerin continues to be popular, many experts believe that it and its derivatives are one of the best groups of drugs used in the treatment of ischemic heart disease.

Nitroglycerin – action

Nitroglycerin and its derivatives belong to the group of nitrates. It works by rapid and strong but short-term widening of blood vessels (mainly veins). It contributes to, among others to reduce oxygen consumption in the heart muscle. In addition, it lowers blood pressure.

See also: How to fight hypertension?

Nitroglycerin – destiny

Nitroglycerin is administered to patients suffering from cardiovascular diseases. Depending on the form of the drug, it may have different purposes.

Nitroglycerin spray is used in the case of:

1. stopping angina attacks,
2. adjunctive therapy in acute left cell failure.

Nitroglycerin in the form of intravenous injections is used in the case of:

1. unstable angina,
2. heart attack,
3. pulmonary edema in the course of acute left ventricular failure,
4. controlled reduction of blood pressure during surgery.

Nitroglycerin in the form of prolonged-release tablets and ointments is used to:

1. preventing angina attacks.

Nitroglycerin – contraindications

The administration of nitroglycerin is not indicated in the case of:

1. hypersensitivity to organic nitrates,
2. arterial hypotension,
3. cardiogenic shock,
4. acute heart failure,
5. severe anemia,
6. intracranial bleeding,
7. constrictive pericarditis,
8. mitral and aortic valve stenosis,
9. allergy to nitroglycerin,
10. cardiac tamponade,
11. the use of phosphodiesterase-5 inhibitors.

Nitroglycerin – warnings

Warnings for taking medications with nitroglycerin:

1. special care should be taken in patients with angle-closure glaucoma,
2. may aggravate the symptoms of angina in the course of hypertrophic cardiomyopathy with obstruction of the outflow tract from the left ventricle,
3. caution should be exercised, among others in case of hypotension, low filling pressure of the ventricles, hypothyroidism.

Nitroglycerin – interactions

Drugs containing nitroglycerin can interact with drugs such as:

1. antihypertensive drugs (drugs that lower blood pressure) – the combined effect of nitroglycerin together with drugs that can lower blood pressure may lead to a dangerous increase in their effect, which may lead to severe fainting;   
2. calcium antagonists;
3. diuretics;
4. ethanol;
5. inhibitory ACE;
6. beta blockers;
7. acetylsalicylic acid – its action may lead to an increase in the concentration of nitroglycerin in the blood, which is probably due to a decrease in clearance, i.e. the ability to remove a given substance from the body, and in this case nitroglycerin;   
8. dihydroergotamina;
9. heparin – nitroglycerin can reduce the effect of heparin, so you should be careful and carefully monitor your anticoagulant treatment when taking these two drugs at the same time;

Before starting nitroglycerin treatment, inform your doctor about all medications you are taking – including over-the-counter medications.

In addition, nitroglycerin must not be taken together with drugs used to treat erectile dysfunction (e.g. sildenafil, tadalafil or vardenafil) which, like nitroglycerin, have a vasodilating effect. If nitroglycerin and drugs used to treat erectile dysfunction are taken at the same time, the blood pressure may drop significantly.

Nitroglycerin – side effects

Taking medicines containing nitroglycerin may be associated with certain side effects. Headaches may appear at the beginning of the treatment. Sometimes there are: dizziness (due to dilation of intracranial blood vessels), vomiting and nausea, reddening of the skin (especially of the facial skin due to dilation of the blood vessels in the skin), drop in blood pressure, weakness, fainting (due to a drop in blood pressure), restlessness, tachycardia, excessive sweating.

Angina symptoms worsen occasionally.

Nitroglycerin – dosage

Nitroglycerin is a drug that should be taken either lying down or sitting. This is due to the body’s reaction to the administration of nitroglycerin, as blood pressure may drop and, as a consequence, faint or even unconscious.

However, when it comes to taking nitroglycerin, you shouldn’t forget not to take it when your systolic blood pressure is less than 100 mm Hg. However, if you feel faint after taking nitroglycerin, then you should lay the person flat as soon as possible, bearing in mind that their legs are raised high and contact the ambulance as soon as possible. Of course, no further doses of nitroglycerin can then be administered.

Nitroglycerin is most often administered in the form of tablets and aerosols that are administered sublingually. As for nitroglycerin administered sublingually in the form of tablets, they work after 2-3 minutes. In the case of an aerosol, it starts working after a minute after administration, and its effect lasts for about 2 hours. In addition, it is worth mentioning that nitroglycerin can be administered in the form of patches applied to the skin and ointments.

In addition, it should also be remembered that nitroglycerin in the form of a tablet will not start working when swallowed, because it is broken down by gastric juice.

Nitroglycerin – affects the ability to drive

When it comes to driving vehicles, operating any machinery or performing other activities with an increased risk of accidents, it is prohibited. This is due to the fact that nitroglycerin may cause dizziness, fainting and other symptoms that may impair psychophysical fitness and the ability to driveand this poses a threat to the life and health of the patient and those around him.

Nitroglycerin – price

The cost of nitroglycerin is not high and amounts to less than PLN 20 per packaging of the drug in the form of an aerosol. When it comes to packaging the drug in the form of tablets, one package costs up to PLN 10. It should be added that nitroglycerin is available only upon presentation of a prescription.

Nitroglycerin – substitutes

It is relatively difficult to replace any other preparation that could be a substitute for nitroglycerin. One of the preparations of this type may be isosorbide mononitrate, which, like nitroglycerin, dilates blood vessels. However, it should be added that, just like nitroglycerin, it is available only on prescription, which means that only a doctor can recommend its use.

Nitroglycerin – storage

Store at room temperature between 15 and 30 degrees Celsius, away from light and moisture. Keep all medications away from children and pets.

Medicines should not be flushed down the toilet or flushed down the drain. The medicine should be properly discarded when the use-by date has expired or is no longer needed. For more information on the safe disposal of the product, please consult your pharmacist or local waste disposal company.

Nitroglycerin – pregnant and breastfeeding women

Studies on the use of this substance in pregnant animals have shown no risk to the fetus. However, there are not enough human studies to show whether a drug is hazardous in human pregnancy. Therefore, nitroglycerin should only be used if the potential benefit justifies the potential risk. Before taking it, it is worth consulting a doctor.

In breastfeeding women, nitroglycerin may pass into breast milk and cause side effects in a child who is breastfed. If a woman is breastfeeding her baby, she should talk to her doctor before using nitroglycerin. You may need to decide whether to stop breastfeeding or to stop taking nitroglycerin.

Myths and misconceptions about nitroglycerin

Nitroglycerin is a pain reliever

Nitroglycerin can reduce angina chest pain by helping to reduce the burden on the heart muscle (and therefore oxygen consumption), but is not itself a pain reliever (pain reliever).

If the patient has chest pain, nitroglycerin will improve their score

While nitroglycerin can help relieve pain from angina and even myocardial infarction, it’s not associated with better outcomes. In addition, long-term exposure to nitroglycerin may inhibit aldehyde dehydrogenase (ALDH2), an enzyme that may play an important cardioprotective role during cardiac events.

Administration of nitroglycerin to a patient with right-sided heart failure causes the patient’s death

Although patients suffering from right-sided heart failure are particularly dependent on the preload which the administration of nitroglycerin reduces, it is usually not considered an absolute contraindication in these patients. Any patient administered nitroglycerin who develops hypotension should receive a trial administration of intravenous fluids. Normal precautions for administering fluids to patients with any type of heart failure are in place, including monitoring of blood pressure and pulmonary murmurs.

If a patient responds to nitroglycerin, he must have heart problems

Nitroglycerin as a drug for smooth muscles often relieves symptoms associated with obstruction or contraction of the gallbladder, as well as irritation and contraction of the esophagus.

Where is the effectiveness of glycerin in the case of coronary heart disease?

During coronary artery disease, patients experience pains, which are a sign that the heart is not getting enough oxygen and is at risk of necrosis. The heart works like a pump in the body, supplying blood to the rest of the body and requires energy and blood with oxygen to function properly. During rest, the heart absorbs 11% of the oxygen consumed by the body, and this value increases even more during exercise. Oxygen cannot be supplied in the correct amount if the blood vessels become constricted and the person experiences chest pain in such cases. Nitroglycerin, in turn, dilates the veins and reduces the heart’s need for oxygen.

Before use, read the leaflet, which contains indications, contraindications, data on side effects and dosage as well as information on the use of the medicinal product, or consult your doctor or pharmacist, as each drug used improperly is a threat to your life or health. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.