CodeBlue
Drug Reference

Cardiac

Nitroglycerin

Nitrate vasodilator

SublingualAdult0.4 mg SL every 5 min × 3
IV infusionAdultStart 10–20 mcg/min, titrate by 5–10 mcg/min
Flash pulmonary edemaAdultHigh-dose: 400–800 mcg SL or 1–2 mcg/kg/min IV

Indications

  • Ischemic chest pain
  • Hypertensive acute pulmonary edema

Contraindications & cautions

  • SBP < 90 or ≥ 30 below baseline
  • RV infarction
  • PDE-5 inhibitor (sildenafil 24 h, tadalafil 48 h)
  • Severe aortic stenosis

Key pearls

  • Relief with nitroglycerin does not distinguish cardiac from non-cardiac pain
  • Headache is common

Used in

Acute Coronary Syndromes