Pregnancy: Risk cannot be ruled out.
Lactation: Caution advised or effect undetermined.
Contraindications: Hypersensitivity to nitrates; hypotensive conditions and hypovolaemia; hypertrophic cardiomyopathy; aortic stenosis; cardiac tamponade; constrictive pericarditis; mitral stenosis; toxic pulmonary oedema; head trauma; cerebral haemorrhage; cerebrovascular disease; marked anaemia.
Precautions: Hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart failure due to obstruction; hypoxaemia or other ventilation and perfusion abnormalities; susceptibility to angle-closure glaucoma; metal-containing transdermal systems should be removed before magnetic resonance imaging procedures, cardioversion, or diathermy; avoid abrupt withdrawal; monitor blood pressure and heart rate during IV infusion.
Cap/Tab/Aerosol/Patch: Treatment and prophylaxis of angina, including variant angina.
Injection: For the control of hypertension during cardiac surgery. Treatment of peri-operative myocardial ischaemia. Unresponsive congestive cardiac failure secondary to acute myocardial infarction. Unstable angina refractory to treatment with standard therapy.
AEROSOL (Sprays: Translingual): Acute attack: Adults: 1 or 2 doses; max 3 per attack. Exercise-induced angina: Adults: 1 or 2 doses before exertion. Hold canister to mouth, spray under tongue and close mouth immediately. Precautions: Patients should not inhale spray. Children: Not recommended.
INJECTION: IV: Adults: 5 mcg/min, increase by 5 mcg/min every 3-5 min to 20 mcg/min; if no response at 20 mcg/min increase by 10 mcg/min every 3-5 min, up
IV: Must be prepared in glass bottles & use special sets intended for nitroglycerin glass IV bottles & administration sets provided by manufacturer.
Sildenafil, tadalafil, vardenafil, ethanol, heparin, alteplase, ergot alkaloids.
Postural hypotension, tachycardia (but paradoxical bradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope, temporary hypoxaemia, rash, application site reactions with transdermal patches; very rarely angle-closure glaucoma. Injection Specific side-effects include severe hypotension, diaphoresis, apprehension, restlessness, muscle twitching, retrosternal discomfort, palpitation, abdominal pain; prolonged administration has been associated with methaemoglobinaemia.