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Organic Nitrate (IV) Pregnancy: C

Glyceryl Trinitrate (IV)

Brand names: Nitrocine, Nitronal

Adult dose

Dose: 10–200 micrograms/min IV infusion; titrate to haemodynamic response
Route: intravenous infusion
Frequency: continuous infusion
Max: 400 micrograms/min
Use PVC-free giving sets (GTN adsorbs to PVC); glass syringe preferred; protect from light; typically start 10 mcg/min and titrate

Paediatric dose

Route: IV
Frequency: continuous infusion
Max: 10 micrograms/kg/min
Concentration: 1 mg/mL (dilute in 5% glucose or 0.9% NaCl) micrograms/min/ml
Specialist use in cardiac surgery and pulmonary hypertension in children

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Clinical pearls

  • Adsorption to PVC — use glass bottles/non-PVC tubing; up to 80% lost to PVC giving sets
  • Tolerance develops within 24–48h of continuous infusion — use lowest effective dose
  • GTN IV reduces heparin effect — increase heparin dose if co-infusing; check APTT more frequently

Contraindications

  • Hypotension (SBP <90 mmHg)
  • PDE5 inhibitors (sildenafil, tadalafil — absolute)
  • Riociguat
  • Hypertrophic obstructive cardiomyopathy
  • Severe aortic stenosis

Side effects

  • Hypotension
  • Headache
  • Tachycardia
  • Methaemoglobinaemia (high doses)
  • Tolerance (prolonged infusion — nitrate-free periods needed)

Interactions

  • PDE5 inhibitors (absolute contraindication)
  • Riociguat (absolute CI)
  • Antihypertensives (enhanced hypotension)
  • IV heparin (GTN reduces heparin effect via decreased antithrombin activity)

Monitoring

  • Blood pressure (continuous)
  • Heart rate
  • Signs of methaemoglobinaemia at high doses

Reference: BNFc; BNF 86; SPC Nitronal. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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