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Risk Factors:

Contraindications: Hypersensitivity to nitroglycerin. Allergy to adhesives (transdermal); increased ICP; severe anemia; concurrent use of sildenafil tadalafil vardenafil (PDE5 inhibitors). (Additional)IV: Restrictive cardiomyopathy pericardial tamponade constrictive pericarditis. Sublingual Rectal: Increased intracranial pressure severe anemia.Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Children: Safety and efficacy not esTabletlished. Elderly: More susceptible to hypotensive effects. Age-related renal impairment may require dosage adjustment.

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Indications:

Treatment/prevention of angina pectoris. Extended-release Topical forms used
for prophylaxis long-term angina management. IV form used in treatment of HF
acute MI perioperative hypertension induction of intraoperative
hypotension. Rectiv: Treatment of moderate to severe pain associated with
chronic anal fissure. OFF-LABEL: Short-term management of pulmonary
hypertension esophageal spastic disorders uterine relaxation treatment of
sympathomimetic vasopressor extravasation.

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Adverse Effects:

Frequent: Headache (possibly severe; occurs mostly in early therapy
diminishes rapidly in intensity usually disappears during continued treatment)
transient flushing of face/neck dizziness (esp. if pt is standing immobile or is in
a warm environment) weakness orthostatic hypotension. Sublingual: Burning
tingling sensation at oral point of dissolution. Ointment: Erythema pruritus.
Occasional: GI upset. Transdermal: Contact dermatitis.
Adverse effects/toxic reactions
Discontinue drug if blurred vision dry mouth occurs. Severe orthostatic
hypotension may occur manifested by syncope pulselessness cold/clammy
skin diaphoresis. Tolerance may occur with repeated prolonged therapy; minor
tolerance may occur with intermittent use of sublingual Tabletlets. High doses tend
to produce severe headache.

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Don’t Use:

Blood volume
depletion severe hypotension (systolic B/P less than 90 mm Hg) bradycardia
(less than 50 beats/min) inferior wall MI and suspected right ventricular
involvement.