Nitroglycerin-Induced Asystole: A Common Therapy with a Rare Adverse Effect

Thomas, Jason; Saenz, E. Muñoz; Haggerty, Paul

doi:10.1016/j.amjmed.2016.06.039

Cited by 5 publications

(1 citation statement)

References 10 publications

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“…61 , 62 There have also been reports of nitroglycerin-induced asystole. 63 Nonetheless, NTG has been a longstanding mainstay for treating angina and ACS and is generally well tolerated with a low risk for major adverse events even when used at exceptionally high doses (up to 121 mg sublingual and transdermal 64 or 56 mg IV bolus 25 ). NTG use in pregnancy is also perceived to be of low risk; however, NTG does cross the placenta and is detectable in the umbilical cord/fetal serum.…”

Section: Safety Profile and Side Effectsmentioning

confidence: 99%

Nitroglycerin Use in the Emergency Department: Current Perspectives

Twiner¹,

Hennessy²,

Wein³

et al. 2022

OAEM

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Nitroglycerin, a fast-acting vasodilator, is commonly used as a first-line agent for angina in the emergency department and to manage chest pain due to acute coronary syndromes. It is also a treatment option for other disease states such as acute heart failure, pulmonary edema, and aortic dissection. Nitroglycerin is converted to nitric oxide, a potent vasodilator, in the body, leading to venodilation at lower dosages and arteriodilation at higher dosages that results in both preload and afterload reduction, respectively. Although nitroglycerin has historically been administered as a sublingual tablet and/or spray, it is often given intravenously in the emergency department as this enables titration to effect with predictable pharmacokinetics. In this review article, we outline the indications, mechanism of action, contraindications, and adverse effects of nitroglycerin as well as review relevant literature and make general recommendations regarding the use of nitroglycerin in the emergency department.

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