Comparative Pharmacology
Head-to-head clinical analysis: NITROMIST versus NITROSTAT.
Peer-Reviewed Evidence
Head-to-head clinical analysis: NITROMIST versus NITROSTAT.
NITROMIST vs NITROSTAT
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
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.
Nitroglycerin is a prodrug that releases nitric oxide (NO), which activates guanylyl cyclase, increasing cGMP in vascular smooth muscle, leading to vasodilation. Preferentially dilates coronary arteries and veins, reducing preload and afterload.
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.
0.3-0.6 mg sublingually or buccally every 5 minutes as needed for angina relief, up to a maximum of 3 doses in 15 minutes.
None Documented
None Documented
2–3 minutes for nitroglycerin; rapid metabolism results in short terminal half-life. Clinically, effects dissipate within 30 minutes of discontinuation.
2–3 minutes for initial distribution phase; terminal elimination half-life is approximately 1–4 minutes. Rapid clearance due to extensive metabolism in the liver and other tissues (via glutathione-organic nitrate reductase).
Renal excretion of inactive metabolites accounts for >80% of elimination; biliary/fecal excretion is minimal (<15%).
Renal excretion of inactive metabolites accounts for approximately 60% of elimination; biliary/fecal excretion accounts for about 35%. Unchanged nitroglycerin is minimally excreted in urine (<1%).
Category C
Category C
Nitrate Vasodilator
Nitrate Vasodilator