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EMR
EMT
AEMT
Paramedic
Extended
Nitroglycerin (Tab, Paste)
Action
Onset
Vasodilator
2 minutes
Indications
Chest Pain / MI
Pulmonary Edema / CHF
Adult Dose
1 tab (0.4 mg) SL every 5 minutes, maintain SBP > 100 mmHg
1” of paste, maintain SBP > 100 mmHg. If hypotension occurs, wipe paste off chest.
Pediatric Dose
Not indicated.
Contraindications
Known hypersensitivity, pericardial tamponade, restrictive cardiomyopathy, constrictive pericarditis, do not
administer if patient has taken the following drugs in the hours stated:
Drug
Hours
Cialis 48
Levitra 24
Viagra 24
Adverse Reactions
Most are dose related to results from nitroglycerin’s activity as a vasodilator. Headache most common.
Transient episodes of lightheadedness, sometimes related to hypotension may occur. Hypotension is infrequent
but may be severe in some patients. Syncope, crescendo angina, and rebound hypertension may occur but they
are uncommon.
Precautions
Severe hypotension and shock can occur even with smaller doses. Use caution with volume depleted patients.
Hypotension induced by nitroglycerin can be accompanied by hypotension and increased angina pectoris.
Considerations
Check for transdermal patch prior to administration.
Nitroglycerin (Tab, Paste)