Comparative Pharmacology
Head-to-head clinical analysis: NITROGLYCERIN versus NITROMIST.
Peer-Reviewed Evidence
Head-to-head clinical analysis: NITROGLYCERIN versus NITROMIST.
NITROGLYCERIN vs NITROMIST
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Nitroglycerin is a vasodilator that is converted to nitric oxide (NO) in vascular smooth muscle cells. NO activates guanylyl cyclase, increasing cGMP levels, leading to dephosphorylation of myosin light chains and vasodilation. Predominantly dilates venous capacitance vessels, reducing preload; also dilates coronary arteries at higher doses.
Nitroglycerin is a prodrug that releases nitric oxide (NO) which activates guanylyl cyclase, increasing cGMP in smooth muscle cells, leading to vasodilation primarily of venous capacitance vessels and coronary arteries.
Sublingual: 0.3-0.6 mg every 5 minutes up to 3 doses for angina; Transdermal: 0.2-0.8 mg/hour patch applied daily for 12-14 hours; Intravenous: 5-200 mcg/min continuous infusion for acute coronary syndromes or heart failure; Topical 2% ointment: 15-30 mg (0.5-1 inch) every 6-8 hours.
1-2 sprays (0.4-0.8 mg) sublingually or intraorally at onset of angina, may repeat every 5 minutes up to 3 doses. Prophylaxis: 1 spray (0.4 mg) 5-10 minutes before activity.
None Documented
None Documented
Clinical Note
moderateNitroglycerin + Etacrynic acid
"The risk or severity of adverse effects can be increased when Nitroglycerin is combined with Etacrynic acid."
Clinical Note
moderateNitroglycerin + Bumetanide
"The risk or severity of adverse effects can be increased when Nitroglycerin is combined with Bumetanide."
Clinical Note
moderateNitroglycerin + Hydrochlorothiazide
"The risk or severity of adverse effects can be increased when Nitroglycerin is combined with Hydrochlorothiazide."
Clinical Note
moderateTerminal half-life: 1–4 minutes for the parent compound; clinical effects dissipate within the same time frame, correlating with rapid metabolism.
2–3 minutes for nitroglycerin; rapid metabolism results in short terminal half-life. Clinically, effects dissipate within 30 minutes of discontinuation.
Metabolized extensively by hepatic glutathione-organic nitrate reductase and other non-specific esterases; renal excretion of metabolites accounts for approximately 50%, with fecal elimination of about 20-30%. Less than 1% of unchanged drug is excreted renally.
Renal excretion of inactive metabolites accounts for >80% of elimination; biliary/fecal excretion is minimal (<15%).
Category C
Category C
Nitrate Vasodilator
Nitrate Vasodilator
Nitroglycerin + Indapamide
"The risk or severity of adverse effects can be increased when Nitroglycerin is combined with Indapamide."