Adult: Initially, 5-10 mcg/min, may be adjusted according to patient's response and tolerability. Doses are administered via IV infusion (usually via infusion pump). Dosage recommendations may vary depending on the type of administration set used and between countries or individual products (refer to specific product guidelines).
Intravenous Induction of intraoperative hypotension, Perioperative hypertension
Adult: Initially, 5-25 mcg/min, may be adjusted according to patient's response and tolerability. Usual dosing range: 10-200 mcg/min. Doses are administered via IV infusion (usually via infusion pump). Dosage recommendations may vary depending on the type of administration set used and between countries or individual products (refer to specific product guidelines).
Intravenous Congestive heart failure
Adult: Initially, 5-25 mcg/min, may be adjusted according to patient's response and tolerability. Doses are administered via IV infusion (usually via infusion pump). Dosage recommendations may vary depending on the type of administration set used and between countries or individual products (refer to specific product guidelines).
Rectal Pain due to chronic anal fissure
Adult: As 0.2% ointment: Apply 1-1.5 cm tid in the anal canal for 2-4 weeks. Include a nitrate-free interval of 12 hours per day (usually overnight). As 0.4% ointment: Apply 2.5 cm (approx 1.5 mg) in the anal canal 12 hourly for up to Max of 8 weeks. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Sublingual Angina pectoris
Adult: For treatment of acute attacks: As tab: Initially, 300-600 mcg at the onset of attack; may be repeated every 5 minutes if angina persists, up to a total of 3 doses within 15 minutes. As sublingual spray (400 mcg/spray): 1 or 2 sprays at the onset of attack; may be repeated every 5 minutes if angina persists, up to a total of 3 sprays within 15 minutes. For prophylaxis: As tab: Initially, 300-600 mcg given 5-10 minutes prior to activities that may provoke angina. As sublingual spray (400 mcg/spray): 1 or 2 sprays 5-10 minutes prior to activities that may provoke angina. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Topical/Cutaneous Angina pectoris
Adult: For prophylaxis: As 2% ointment: Initially, apply 1/2 inch (7.5 mg) upon rising in the morning and another 1/2 inch (7.5 mg) 6 hours later; dose may be doubled to 1 inch and subsequently doubled again to 2 inches if response is insufficient. Include a nitrate-free interval of 10-12 hours per day. Refer to specific product guidelines for detailed instructions on application.
Transdermal Angina pectoris
Adult: For prophylaxis: As patch releasing 5 mg/24 hours or 10 mg/24 hours: Initially, apply 1 patch daily, may be increased if necessary up to a Max of 20 mg daily. As patch releasing 0.1 mg/hour, 0.2 mg/hour, 0.4 mg/hour or 0.6 mg/hour: Initially, 0.2-0.4 mg/hour, may be increased up to a Max of 0.8 mg/hour according to patient's response and tolerability. Patch may remain on the skin for 12-14 hours daily, followed by 10-12 hours daily patch-off period (nitrate-free interval). Apply the patch to a dry, clean and hair-free area. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
What are the brands available for Glyceryl trinitrate in Malaysia?
IV infusion: Dilute in either NaCl 0.9% or dextrose 5% in water solution. Max concentration: 400 mcg/mL. Solutions should be prepared in glass bottles or containers not made with PVC. Recommendations on the final concentration may vary among countries and between individual products. Refer to local or specific product guidelines for detailed instructions.
Incompatibility
IV: Incompatible with polyvinylchloride (PVC); severe losses of glycerl trinitrate may occur, resulting in decreased delivered dose and efficacy.
Contraindications
Hypertrophic obstructive cardiomyopathy, increased intracranial pressure (e.g. cerebral haemorrhage, head trauma), severe anaemia, acute circulatory failure or shock, constrictive pericarditis, pericardial tamponade, severe hypotension, uncorrected hypovolaemia, aortic or mitral stenosis. Concomitant use with phosphodiesterase type 5 inhibitors (e.g. sildenafil, vardenafil, tadalafil) and soluble guanylate cyclase stimulators (e.g. riociguat). Contraindications may vary among countries and between individual products (refer to specific product labelling for detailed information).
Special Precautions
Patient with orthostatic dysfunction, cerebrovascular disease, lung disease or cor pulmonale, hypothyroidism, hypoxaemia, hypothermia, recent history of MI, malnutrition, susceptibility to angle-closure glaucoma, low filling pressures (e.g. acute MI, impaired left ventricular function). Avoid abrupt withdrawal (particularly during long-term use). Severe renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Precipitate or aggravate increased intracranial pressure; development of tolerance (excessive use); severe hypotension (particularly with upright posture) and shock, paradoxical bradycardia, increased angina pectoris, orthostatic hypotension; headache (may be severe); methaemoglobinaemia (particularly with high doses). Cardiac disorders: Tachycardia. Ear and labyrinth disorders: Vertigo. Gastrointestinal disorders: Nausea, vomiting. General disorders and administration site conditions: Asthenia; application site erythema, pruritus, burning and irritation (transdermal). Investigations: Decreased blood pressure. Nervous system disorders: Dizziness, drowsiness. Skin and subcutaneous tissue disorders: Rash, exfoliative dermatitis. Vascular disorders: Flushing, syncope.
This drug may cause dizziness, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood pressure and heart rate.
Overdosage
Symptoms: Severe hypotension, persistent throbbing headache, visual disturbance, palpitation, flushing and perspiring skin (later becoming cold and cyanotic), vertigo, nausea and vomiting (possibly with colic and bloody diarrhoea), syncope (particularly in upright posture), methaemoglobinaemia with cyanosis and anorexia, heart block, initial hyperpnoea, dyspnoea, slow breathing, slow pulse (dicrotic and intermittent), increased intracranial pressure with cerebral symptoms of confusion and moderate fever, paralysis and coma followed by clonic convulsions and circulatory collapse. Management: Supportive treatment. Assess vital signs and mental status. Increase central fluid volume. Keep the patient in a shock position and comfortably warm. IV infusion of normal saline or similar fluid may also be needed. Administer oxygen and initiate artificial ventilation, if needed. In case of methaemoglobinaemia, administer IV methylthioninium chloride (methylene blue) 1% solution at a dose of 1-2 mg/kg unless the patient is known to have G6PD deficiency. May perform gastric lavage if excessive quantity has been recently swallowed.
Drug Interactions
May potentiate hypotensive effects with vasodilators, antihypertensives (e.g. β-blockers, calcium channel blockers, ACE inhibitors, diuretics), neuroleptics, TCAs, sapropterin and apomorphine. May potentiate vasodilator effect with acetylcysteine. May alter the anticoagulant effect of heparin. May reduce the serum concentration of alteplase. Ergot alkaloids may antagonise the coronary vasodilation effect of glyceryl trinitrate. Drugs that cause dry mouth (e.g. anticholinergics or antimuscarinic agents) may reduce the efficacy of sublingual glyceryl trinitrate. Potentially Fatal: Increased risk of severe hypotension, syncope or myocardial ischaemia with phosphodiesterase type 5 inhibitors (e.g. sildenafil, vardenafil, tadalafil). Increased risk of hypotension with soluble guanylate cyclase stimulators (e.g. riociguat).
Food Interaction
Increased risk of hypotension and syncope with alcohol.
Action
Description: Mechanism of Action: Glyceryl trinitrate is an organic nitrate that forms free radical nitric oxide (NO) which stimulates guanylate cyclase and increases cyclic guanosine 3’5’ monophosphate (cGMP) in the smooth muscle, resulting in dephosphorylation of myosin light chains and relaxation of smooth muscle cells and thereby producing vasodilation. Following intra-anal administration, it decreases the anal sphincter tone leading to reduced resting intra-anal pressure. Synonym(s): Nitroglycerin. Onset: 1-3 minutes (sublingual tab and spray); within 1-2 minutes (IV); 15-30 minutes (topical); approx 30 minutes (transdermal). Duration: At least 25 minutes (sublingual tab); 3-5 minutes (IV); 7 hours (topical); 10-12 hours (transdermal). Pharmacokinetics: Absorption: Rapidly absorbed from the oral mucosa; well absorbed from the gastrointestinal tract and the skin. Distribution: Widely distributed in the body. Crosses the placenta. Volume of distribution: Approx 3 L/kg. Plasma protein binding: Approx 60%. Metabolism: Metabolised in the liver by liver reductase enzyme into glycerol mononitrate and dinitrate metabolites, which are further metabolised into glycerol and organic nitrate; extrahepatic metabolism by red blood cells and vascular walls also occurs. Undergoes extensive first-pass metabolism. Excretion: Via urine (as inactive metabolites). Elimination half-life: Approx 1-4 minutes.
Chemical Structure
Glyceryl trinitrate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4510, Nitroglycerin. https://pubchem.ncbi.nlm.nih.gov/compound/Nitroglycerin. Accessed Aug. 28, 2025.
Storage
Sublingual tab or spray/IV inj/Patch/Rectal ointment: Store below 30°C. Topical ointment: Store below 25°C. Storage recommendations may vary between individual products. Refer to specific product guidelines.
C01DA02 - glyceryl trinitrate ; Belongs to the class of organic nitrate vasodilators. Used in the treatment of cardiac disease. C05AE01 - glyceryl trinitrate ; Belongs to the class of muscle relaxants. Used in the topical treatment for the treatment of hemorrhoids and anal fissures.
References
Brayfield A, Cadart C (eds). Glyceryl Trinitrate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/04/2025.Deponit 10 mg/24 h Transdermal Patch (Norgine Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk. Accessed 10/04/2025.Deponit 5 mg/24 h Transdermal Patch (Norgine Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk. Accessed 10/04/2025.Douglas Pharmaceuticals Ltd. Nitrolingual Pumpspray 0.4 mg data sheet 12 June 2018. Medsafe. http://www.medsafe.govt.nz. Accessed 10/04/2025.Gitrinil Injection 10 mL Amp (Duopharma [M] Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/04/2025.GLICE Glyceryl Trinitrate 1 mg/mL Solution for Injection for Infusion (Averroes Pharmaceuticals Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/04/2025.Glyceryl Trinitrate 1 mg/mL Solution for Infusion (Hameln Pharma Ltd). MHRA. https://products.mhra.gov.uk. Accessed 10/04/2025.Glyceryl Trinitrate [Nitroglycerin]. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 02/05/2025.Glyceryl Trinitrate Spray 400 micrograms/metered dose, Sublingual Spray (Ayrton Saunders Ltd). MHRA. https://products.mhra.gov.uk. Accessed 10/04/2025.Glyceryl Trinitrate Tablets 500 micrograms (Bristol Laboratories Ltd). MHRA. https://products.mhra.gov.uk. Accessed 10/04/2025.GTN Actavis Tablet 500 mcg (DCH Auriga [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/04/2025.Joint Formulary Committee. Glyceryl Trinitrate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/04/2025.Nitro-BID Ointment (Savage Laboratories a Division of Fougera Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/04/2025.Nitro-Dur Patch (Ingenus Pharmaceuticals, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 17/07/2025.Nitroglycerin (Systemic). UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 18/07/2025.Nitroglycerin (Topical). UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 10/04/2025.Nitroglycerin Injection, Solution (American Regent, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/04/2025.Nitroglycerin Injection, Solution (Henry Schein, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/04/2025.Nitroglycerin Tablet (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/04/2025.Nitroglycerin Tablet, Orally Disintegrating (Redpharm Drug). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/04/2025.Nitroglycerin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 18/07/2025.Nitrolingual Spray (Allegis Pharmaceuticals, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 17/07/2025.Nitrosol Sublingual Aerosol Spray 400 mcg/actuation (Vitamode Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/04/2025.Pfizer New Zealand Limited. DBL Glycerly Trinitrate, Solution for Injection, 50 mg/10 mL data sheet 03 November 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 10/04/2025.Pharmacy Retailing (NZ) Ltd t/a Healthcare Logistics. Rectogesic Ointment data sheet 29 December 2016. Medsafe. http://www.medsafe.govt.nz. Accessed 10/04/2025.Rectiv Ointment (Allergan, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/04/2025.Rectogesic 4 mg/g Rectal Ointment (Grunenthal Ltd). MHRA. https://products.mhra.gov.uk. Accessed 10/04/2025.Sandoz New Zealand Limited. Nitroderm TTS 5 Transdermal Patch and Nitroderm TTS 10 Transdermal Patch data sheet 28 August 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 10/04/2025.
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