IV nitroglycerine alternatives

Background

Suggestions for substitution during the IV shortage

Nitroglycerine Bioavailability

Oral [1]: <1%
Sublingual [1]: 38% (15-40%)
Topical [1]: 72%

Half-life[2]: 0.05 h

Suggested Substitutions[3]

Sublingual nitroglycerin, 1-2 tabs or sprays every 5 minutes as needed
- Once controlled
  - Nitroprusside OR Isordil PO (nitro paste or longer acting NTG)
- If not well controlled
  - IV enalapril 0.625-1.25mg IV bolus
  - IV hydralazine 5-10mg IV bolus
  - IV nitroprusside

See Also

References

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