Nitro-Bid IV, Tridil infusion

Brand Name(s): Nitro-Bid IV, Tridil
Generic Name Nitroglycerin Injection

What is nitroglycerin injection?
NITROGLYCERIN (Nitro-Bid® IV, Tridil®) is a type of vasodilator. It relaxes blood vessels, increasing the blood and oxygen supply to your heart. Nitroglycerin infusions are used to help relieve the pain associated with angina that does not respond to oral (by mouth) treatment; to control blood pressure; and to help treat congestive heart failure. Generic nitroglycerin injections are available.

INDICATIONS

• relief of refractory or unstable angina, control of congestive heart failure
• control of hypertension during coronary artery bypass graft surgery
• management of hypertensive emergency
• as a premedication, diagnostic tool and for the treatment of angina in cardiac catheter lab
• acute myocardial infarction

ROUTES OF ADMINISTRATION

• Nitroglycerin injection must be diluted before use to a concentration not exceeding 400 mcg/mL
• IV Infusion: Starting with a concentration of 200 mcg/mL (50 mg in a 250 mL D5W) the rate of administration using a volumetric pump can be calculated as:

Number of mL/hour = [Desired dose (mcg/min) x 60 (min/hr)] / concentration (i.e. 200 mcg/mL)

• The infusion may be increased to an approximate concentration of 400 mcg/mL (100 mg in 250 mL D5W) if necessary in fluid restricted patients

ADMINISTRATION POLICY

Use is restricted to Critical Care Areas

ECG monitoring required during IV administration.

The IV infusion administration rate MUST be controlled by an automated infusion control device.

DOSAGE

• there is no fixed optimum dose of nitroglycerin; each patient must be titrated to response
• Usual dose - 0.2 - 1.5 mcg/kg/minute

• initial dosage: 0.2 mcg/kg/min with increases in increments of 0.1 mcg/kg/min every 3-5 minutes until response is noted; if no response is seen at 0.3 mcg/kg/min, increments of 0.2-0.4 mcg/kg/min can be used

ALTERNATELY,

• initial dosage; 5 mcg/minute with increases in increments of 5 mcg/minute every 3-5 minutes until response is noted; if no response is seen at 20 mcg/min, increments of 10 and later 20 mcg/min can be used
• once a partial response is observed, the dose increase should be reduced and the interval between increases lengthened

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• headache, severe hypotension, reflex tachycardia

IMPORTANT IMPLICATIO

• adequate systemic blood pressure and coronary perfusion must be maintained
• contraindicated in hypotension, uncorrected hypovolemia, increased intracranial pressure, constrictive pericarditis and pericardial tamponade