Nitroglycerin Ointment

Aka: Nitroglycerin Ointment, Nitroglycerin Paste, NItro-Bid Ointment

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II. Indications

  1. Congestive Heart Failure Exacerbation Management
    1. Nitroglycerin Infusion is used in critical CHF exacerbations for rapid Preload reduction
    2. Less severe CHF exacerbations may benefit from early Nitroglycerin Ointment during initial stabilization
      1. Unlike Nitroglycerin Infusion that requires ED/ICU care, Nitroglycerin Ointment may be used on regular medical wards
  2. Angina Pectoris
    1. Other Nitroglycerin preparations are preferred for acute Angina (e.g. Sublingual Nitroglycerin, Nitroglycerin Infusion)
    2. For chronic Angina, use Long Acting Nitroglycerin (e.g. Isosorbide or Nitroglycerin Patch) instead

III. Precautions

  1. Poor absorption (Other preparations are preferred)

IV. Pharmacokinetics

  1. One inch of ointment equivalent to 10 mcg/min IV infusion

V. Dosing

  1. Nitroglycerin 2% ointment (15 mg per inch)
    1. Start: 0.5 inch every 8 hours
    2. Maintenance: 1-2 inches every 8 hours
    3. Maximum: 4-5 inches every 4 to 6 hours

VI. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

VII. Mechanism

  1. See Nitroglycerin

VIII. Adverse Effects

  1. See Nitroglycerin

IX. Resources

  1. Nitro-Bid Nitroglycerin Ointment
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e464e9bb-48e8-4b9f-9fff-e220cfbac0c5

X. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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