Glyceryl trinitrate Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Monitoring requirements - see overleaf
Adsorbs on to PVC- see under Methods of intravenous administration and also Further information
For Y-site compatibility see below

Glyceryl trinitrate 50mg per 50mL vial (Hameln) - unlicensed

Nitro POHL Infus 10mg per 10mL ampoule (labelled nitroglycerin = glyceryl trinitrate) - unlicensed

Nitronal 50mg in 50mL vial - unlicensed

Already in solution

Draw up using a 5 micron filter needle (ampoule)

Not required - product ready for infusion (but see also Further Information)

Continuous intravenous infusion (administer using an electronically controlled infusion device)

Administered as a continuous intravenous infusion as per dosage guidelines overleaf
The drug must be prepared in a syringe pump (as syringe pumps are low adsorption), and must be given via a low-adsorption giving set (e.g Braun Original Perfusor -Leitung PE 8723060 or Vygon Lectro-spiral 1155.80)

Usual dose range as follows:

Unresponsive congestive heart failure

Dose range 0.6 to 6mg per hour with frequent monitoring of blood pressure and heart rate
Commence at lower rate and increase cautiously in steps of 1.2 to 1.5mg per hour every 15 to 30 minutes until desired clinical response is achieved

Refractory unstable angina pectoris

An initial infusion rate of 0.6 to 0.9mg per hour is recommended; this may be increased cautiously in increments of 0.3 to 0.6mg per hour, at approximately 30 minute intervals, until either relief of angina is achieved, headache prevents further increase in dose, or the mean arterial pressure falls by more than 20mmHg

Use in surgery for hypertension

An initial infusion rate of 1.5mg per hour is recommended; this should be increased gradually in increments of 1.5mg per hour at five minute intervals, until the desired systolic arterial pressure is attained
The usual dose is 0.6 to 12mg per hour
In some cases doses of up to 24mg per hour have been required

Monitor blood pressure and heart rate
Also consider pulmonary capillary wedge pressure, cardiac output, and precordial electrocardiogram, depending on the clinical picture.

If the product is to be given as a large volume infusion, e.g. final volume 500ml of either Sodium chloride 0.9% or Glucose 5%, it must be in a low adsorption infusion bottle (eg Braun Ecoflac or Baxter Viaflo), and it must be given via a low adsorption giving set (Baxter VMC9606, or Braun 8700110SP)
There are subtle differences in doses between the different manufacturers, for different indications - titrate the dose to effect

GTN 50mg/50mL - (Hameln) UK SPC 06/05/2021

Nitronal 1mg/1mL UK SPC 12/11/2019

Nitrate

Search synonym GTN