This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Glyceryl trinitrate parenteral

Updated 2 Feb 2023 | Parenteral nitrates


Infusions of glyceryl trinitrate

Drugs List

  • glyceryl trinitrate 50mg/50ml solution for infusion
  • glyceryl trinitrate 5mg/5ml solution for infusion
  • NITRONAL 50mg/50ml infusion
  • NITRONAL 5mg/5ml infusion
  • Therapeutic Indications


    Angina - unstable and refractory to treatment
    Congestive heart failure (resistant to other treatment)
    Congestive heart failure secondary to acute myocardial infarction
    Heart failure with cardiac surgery- Vasodilatation and inotropic support
    Intra-operative hypertension
    Prinzmetal angina

    Unlicensed Uses

    Hypertension - crisis


    Dosage should be titrated to individual requirements.

    Continuous monitoring of the patient is required throughout treatment to assess the response to the drug and adjust the dosage accordingly.

    Initialise therapy at a lower rate and gradually increase until the desired clinical response is achieved.


    Unresponsive congestive heart failure
    Starting dose is 20 to 25 micrograms/minute.
    This may be decreased to 10 micrograms/minute or increased in incremental steps of 20 to 25 micrograms/minute every 15 to 30 minutes until desired effect is achieved.
    Dose range is 10 to 100 micrograms/minute as a continuous infusion, however up to 400 micrograms/minute may be required.

    Unstable angina
    Initially infuse at a rate of 10 micrograms/minute.
    This may be increased cautiously in increments of 10 micrograms at approximately 30 minute intervals.

    During surgery
    Initially infuse at a rate of 25 micrograms/minute
    Increase gradually by increments of 25 micrograms/minute at 5 minute intervals until the desired blood pressure is stabilised.
    Normal dose range is 10 to 200 micrograms/minute, however up to 400 micrograms/minute may be required.


    Coronary vasoconstriction in myocardial ischaemia; Heart failure after cardiac surgery; Hypertension during and after cardiac surgery; Vasoconstriction in shock (unlicensed)
    Initial dose: 0.2 to 0.5 micrograms/kg/minute. Titrate to response.
    Maintenance dose: 1 to 3 micrograms/kg/minute.
    Maximum dose: 10 micrograms/kg/minute (do not exceed 200 micrograms/minute).


    Coronary vasoconstriction in myocardial ischaemia; Heart failure after cardiac surgery; Hypertension during and after cardiac surgery; Vasoconstriction in shock (unlicensed)
    0.2 to 0.5 micrograms/kg/minute. Titrate to response.
    Maintenance dose: 1 to 3 micrograms/kg/minute.
    Maximum dose: 10 micrograms/kg/minute.


    For intravenous infusion only.

    Administer using a syringe pump with glass syringe, a micro drip infusion pump or a similar device that allows continuous controlled infusion rate. Glass or polythene containers are required for delivery of the solution. Rate of infusion is individually determined according to condition and haemodynamic response. It is also recommended to consult the dosage chart that is provided with the preparation.


    Aortic stenosis
    Cardiac tamponade
    Cerebrovascular haemorrhage
    Circulatory failure
    Constrictive pericarditis
    Head trauma
    Hypertrophic obstructive cardiomyopathy
    Mitral stenosis
    Raised intracranial pressure
    Severe anaemia
    Severe hypotension
    Toxic pulmonary oedema

    Precautions and Warnings

    Children under 18 years
    Congestive cardiac failure secondary to mechanical obstruction
    Narrow angle glaucoma
    Recent myocardial infarction
    Severe hepatic disorder
    Severe renal disorder

    Monitor blood pressure continuously
    Methaemoglobinaemia may develop with prolonged administration
    Monitor haemodynamics of circulation
    Monitor heart rate
    Cross tolerance to other nitrates may develop
    Reduce dose or discontinue if symptoms of severe bradycardia occur
    Tolerance may develop with continued use
    Hypotensive effects may be potentiated by alcohol

    Pregnancy and Lactation


    Use glyceryl trinitrate with caution in pregnancy.

    Glyceryl trinitrate is primarily used for treatment and prevention of angina and therefore experience of use in pregnancy is limited. Glyceryl trinitrate should not be used during pregnancy particularly during the first trimester unless the potential benefits outweigh the unknown risks to the foetus (Briggs, 2011). Schaefer (2007) comments that nitrates may be used in pregnancy for appropriate indications and toxic affects on the foetus have not been reported. Briggs (2011) adds that with smaller doses of nitrates a transient decrease in the mother's blood pressure may occur but does not seem to be sufficient to affect placental perfusion.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use glyceryl trinitrate with caution in breastfeeding.

    Infusions of glyceryl trinitrate have not been studied during breastfeeding.

    Studies with other topical preparations (ointment) have been used to treat anal fissures on nursing mothers and there were no reported effects in the breastfed infant whilst a number of the known side effects (headache, dizziness, lightheaded) where reported in the mothers.

    It is recommended that infants be observed for flushing and discomfort following breastfeeding, since it is not known if glyceryl trinitrate is secreted in the breast milk. Hale (2010) recommends monitoring for methemoglobinemia and breastfeeding with caution at increased dosages with prolonged exposure, particularly in infants younger than 6 months.

    Toxic effects on the infant have not been reported; Schaefer (2007) states that data would argue against a toxic risk for the breastfed infant due to the short half-life of the drug and its usually brief use.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal pain
    Glaucoma (closed angle)
    Muscle twitch
    Postural hypotension
    Retrosternal discomfort


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2013

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Glyceryl Trinitrate 1mg/ml solution for infusion. Hameln Pharmaceuticals Ltd. Revised June 2009.

    Summary of Product Characteristics: Nitrocine. UCB Pharma Ltd. Revised March 2013.

    Summary of Product Characteristics: Nitronal. Merck Serano. Revised December 2011.

    NICE Evidence Services Available at: Last accessed: 25 August 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Nitroglycerin Last revised: September 7, 2013
    Last accessed: September 5, 2013

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.