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Technical details about Nitroglycerin, learn more about the structure, uses, toxicity, action, side effects and more

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2D Structure
Also known as: Glyceryl trinitrate, Trinitroglycerin, Nitrostat, 55-63-0, Nitroglycerine, Nitroglycerol
Molecular Formula
C3H5N3O9
Molecular Weight
227.09  g/mol
InChI Key
SNIOPGDIGTZGOP-UHFFFAOYSA-N
FDA UNII
G59M7S0WS3

A volatile vasodilator which relieves ANGINA PECTORIS by stimulating GUANYLATE CYCLASE and lowering cytosolic calcium. It is also sometimes used for TOCOLYSIS and explosives.
Nitroglycerin is a Nitrate Vasodilator. The physiologic effect of nitroglycerin is by means of Vasodilation.
1 2D Structure

2D Structure

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
1,3-dinitrooxypropan-2-yl nitrate
2.1.2 InChI
InChI=1S/C3H5N3O9/c7-4(8)13-1-3(15-6(11)12)2-14-5(9)10/h3H,1-2H2
2.1.3 InChI Key
SNIOPGDIGTZGOP-UHFFFAOYSA-N
2.1.4 Canonical SMILES
C(C(CO[N+](=O)[O-])O[N+](=O)[O-])O[N+](=O)[O-]
2.2 Other Identifiers
2.2.1 UNII
G59M7S0WS3
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Anginine

2. Dynamite

3. Gilustenon

4. Glyceryl Trinitrate

5. Nitrangin

6. Nitro Bid

7. Nitro Dur

8. Nitro-bid

9. Nitro-dur

10. Nitrobid

11. Nitrocard

12. Nitroderm

13. Nitroderm Tts

14. Nitrodur

15. Nitroglyn

16. Nitrol

17. Nitrolan

18. Nitrong

19. Nitrospan

20. Nitrostat

21. Perlinganit

22. Susadrin

23. Sustac

24. Sustak

25. Sustonit

26. Transderm Nitro

27. Tridil

28. Trinitrate, Glyceryl

29. Trinitrin

30. Trinitrolong

2.3.2 Depositor-Supplied Synonyms

1. Glyceryl Trinitrate

2. Trinitroglycerin

3. Nitrostat

4. 55-63-0

5. Nitroglycerine

6. Nitroglycerol

7. Glycerol Trinitrate

8. Nitro-dur

9. Minitran

10. Trinitroglycerol

11. Trinitrin

12. Tridil

13. Transderm-nitro

14. Nitrolingual

15. Nitroderm

16. Nitroglyn

17. Nitronet

18. Nitrospan

19. Nitora

20. Transderm Nitro

21. Nitro-bid

22. Epinitril

23. Lenitral

24. Natispray

25. Nitrocine

26. Nitrolan

27. Perlinganit

28. Susadrin

29. Sustonit

30. Nitrong

31. Niong

32. Nitromist

33. Nitroderm Tts

34. Propane-1,2,3-triyl Trinitrate

35. Angiolingual

36. Cordipatch

37. Corditrine

38. Glycerin Trinitrate

39. Klavikordal

40. Myoglycerin

41. Nitroglicerina

42. Nitroletten

43. Nitroplast

44. Nitrorectal

45. Nitroretard

46. Nitrostabilin

47. Nysconitrine

48. Perglottal

49. Rectogesic

50. Temponitrin

51. Trinitrosan

52. Adesitrin

53. Angibid

54. Angorin

55. Cardamist

56. Chitamite

57. Deponit

58. Glonoin

59. Glytrin

60. Millisrol

61. Niglycon

62. Nitrodisc

63. Nitrogard

64. Nitroglin

65. Nitrolowe

66. Nitromel

67. Nitromex

68. Nitromint

69. Nitronal

70. Percutol

71. Suscard

72. Trinalgon

73. Triniplas

74. Trinitrol

75. Vasoglyn

76. Myocon

77. Niglin

78. Gilucor Nitro

79. Nitrocor

80. Soup

81. Blasting Oil

82. Blasting Gelatin

83. Glyceryl Nitrate

84. Nitro-lent

85. Nitrozell Retard

86. Transiderm-nitro

87. Coro-nitro

88. Nitro-span

89. Nitrine-tdc

90. Spirit Of Glonoin

91. Nitrolingual Spray

92. 1,2,3-propanetriol, Trinitrate

93. Nitrogliceryna

94. Glonoinum

95. Rectiv

96. Transderm-nitro Tts

97. Glyceroltrinitraat

98. Propanetriol Trinitrate

99. Nitro Iv

100. 1,2,3-propanetriyl Nitrate

101. Glycerol, Nitric Acid Triester

102. Gonitro

103. 1,3-dinitrooxypropan-2-yl Nitrate

104. Nitroglycerin, Spirits Of

105. Spirit Of Trinitroglycerin

106. Ng

107. Rcra Waste Number P081

108. Sk-106n

109. Solution Glyceryl Trinitrate

110. Spirit Of Glyceryl Trinitrate

111. Nk-843

112. Trinitrine

113. Glycerol(trinitrate De)

114. 1,2,3-propanetriol Trinitrate

115. Ntg

116. Imx-150

117. 1,2,3-propanetrioltrinitrate

118. Glycerol Nitric Acid Triester

119. Diluted Nitroglycerin

120. C01da02

121. Gilustenon

122. Trinitrolong

123. Sustak

124. Gtn

125. Nitrobid

126. 1,2,3-propanetriol, 1,2,3-trinitrate

127. G59m7s0ws3

128. Aldonitrin

129. Cardiodisco

130. Colenitral

131. Discotrine

132. Glycerylnitrat

133. Lentonitrina

134. Nitrobukal

135. Nitrocerin

136. Nitrocontin

137. Nitropatch

138. Nitropercuten

139. Nitroperlinit

140. Nitropront

141. Nitroprontan

142. Plastranit

143. Ratiopharm

144. Tng

145. Trinipatch

146. Angiplex

147. Angonist

148. Buccard

149. Cardabid

150. Cardinit

151. Dauxona

152. Diafusor

153. Dtxsid1021407

154. Glyceryl

155. Herwicard

156. Minitram

157. Mionitrat

158. Nitradisc

159. Nitroard

160. Nitrobaat

161. Nitroclyn

162. Nitrocot

163. Nitrodyl

164. Nitrolin

165. Nitropen

166. Nitroprol

167. Nitrorex

168. Nitrovis

169. Perganit

170. Polnitrin

171. Trinitron

172. Turicard

173. Vasolator

174. Vernies

175. Willong

176. Anglix

177. Chebi:28787

178. Herzer

179. Myovin

180. Nirmin

181. Nitrek

182. Sustac

183. Nitrol Ointment

184. Trinitrina Erba

185. Nitradisc Pad

186. Nitro-pflaster

187. Nitrobid Oint

188. Nitrong Retard

189. Niong Retard

190. Nitro Retard

191. Aquo-trimitrosan

192. Nitro Rorer

193. Nitromack Retard

194. Nitromint Retard

195. Nitronal Aqueous

196. Nitro-time

197. Nitrogard-sr

198. Mi-trates

199. Nitradisc Tts

200. Nitriderm Tts

201. Nitro-par

202. Top-nitro

203. Nitrocine 5

204. Nitrodyl Tts

205. Nitromint Aerosol

206. Nitrong-sr

207. Deponit 5

208. Deponit-5

209. Neos Nitro Opt

210. Nit-ret

211. Nitroglycerin-acc

212. Transderm-n Tts

213. Nitro Mack Retard

214. Nitro-m-bid

215. Nitro-mack Retard

216. Gepan Nitroglicerin

217. Nitro Dur Tts

218. Nitroderm Tts-5

219. Gtn-pohl

220. Nitroderm Tts Ext

221. Nitro-dur 5

222. Nitrocontin Continus

223. Deponit Tts 5

224. Nitro-gesanit Retard

225. Cellegesic

226. Deponit Tts 10

227. Nitro-dur 10

228. Nitrocap

229. Nitroquick

230. Nitroquik

231. Glycerintrinitrate

232. Percutol Oint.

233. Nitrong Parenteral

234. Nitrocapt.d.

235. Glycerine Trinitrate

236. Nitroglycerin (ng)

237. Corangin Nitrokapseln

238. Trinitroglicerina Fabra

239. Anogesic

240. Minitro

241. Nitriderm

242. Nitroject

243. Vascana

244. Buccal

245. Nitrogliceryna [polish]

246. Nitroglycerine [french]

247. Nitrol (pharmaceutical)

248. Tridil Sublin

249. Trinitrine Simple Laleuf

250. Nitroglicerina [italian]

251. Nitroglicerina [spanish]

252. Aquo-trinitrosan

253. Glycerintrinitrate [czech]

254. Glyceroltrinitraat [dutch]

255. Trinitrin Tablets

256. Nitrolingual Pumpspray

257. Nitromist (tn)

258. Minitran (tn)

259. Hsdb 30

260. Sdm No. 17

261. Nitroglycerin In Dextrose 5%

262. Nitro-bid (tn)

263. Nitro-dur (tn)

264. Ccris 4089

265. Nitroglycerin Ointment

266. Nitric Acid Triester Of Gylcerol

267. Transderm-nitro (tn)

268. Glycerol(trinitrate De) [french]

269. Glycerol (trinitrate De) [french]

270. Glycerol (trinitrate De)

271. Einecs 200-240-8

272. Un0143

273. Un1204

274. Un3064

275. Un3319

276. Nitroglycerin [usp:jan]

277. Rcra Waste No. P081

278. Brn 1802063

279. Unii-g59m7s0ws3

280. 2,3-dinitrooxypropyl Nitrate

281. Nitrofortin

282. Nitrolande

283. Nitrosigma

284. Reminitrol

285. Solinitrina

286. Spirits Of Nitroglycerin, (1 To 10%)

287. Corangil

288. Nitrolar

289. Nitromed

290. Sutonit

291. Myocor

292. Trans-nitro

293. Glonoine Oil

294. Nitro Mack

295. S.n.g.

296. 2,3-bis(nitrooxy)propyl Nitrate

297. Mqx-503

298. Nitro-prn

299. Med-2002

300. Nitroglycerin Tablets

301. Sk-866

302. Sk-878

303. Un0144

304. Nitroglycerin Injection

305. Spirits Of Nitroglycerin

306. Glonoinum [hpus]

307. Nitroglycerine, Spirit Of

308. 1,2,3-trinitrooxypropane

309. Nitroglycerin [mi]

310. Chembl730

311. Ec 200-240-8

312. Glyceryl Trinitrate Solution

313. Nitroglycerin (jp17/usp)

314. Nitroglycerin [hsdb]

315. 1,2,3-trinitroglycerin-d5

316. Schembl15421

317. Nitroglycerin [vandf]

318. 4-01-00-02762 (beilstein Handbook Reference)

319. Un 0143 (salt/mix)

320. Un 0144 (salt/mix)

321. Un 1204 (salt/mix)

322. Bidd:gt0142

323. Nitroglycerin, Liquid, Not Desensitized [forbidden]

324. Sdm No. 17 (salt/mix)

325. Sdm No. 27 (salt/mix)

326. 1,2,3-propanetriol Trinatrate

327. 1,2,3-tris-nitryloxy-propane

328. Gtpl7053

329. Trinitrate 1,2,3-propanetriol

330. Nitric Acid Triester Of Glycerol

331. Hms2094m15

332. Nitroglycerin [orange Book]

333. Nitroglycerin Tablets [jan]

334. Glyceryl Trinitrate [mart.]

335. Zinc8214625

336. Nitroglycerin [usp Impurity]

337. C0061

338. Glyceryl Trinitrate [who-dd]

339. Akos030254238

340. Diluted Nitroglycerin [usp-rs]

341. Nitroglycerin, Solution In Alcohol With > 5% But Not > 10% Nitroglycerin

342. Db00727

343. Nitroglycerin, Liquid, Not Desensitized

344. Diluted Nitroglycerin [usp Monograph]

345. Ft-0752897

346. C07455

347. D00515

348. Glyceryl Trinitrate Solution [ep Monograph]

349. Q162867

350. Sr-01000944510

351. Sr-01000944510-1

352. Nitroglycerin, Solution In Alcohol, With Not >1% Nitroglycerin

353. Nitroglycerin, Solution In Alcohol, With >1% But Not >10% Nitroglycerin

354. Nitroglycerin, Solution In Alcohol, With >1% But Not >5% Nitroglycerin

355. Nitroglycerin Mixture With >2% But Not >10% Nitroglycerin, By Mass, Desensitized

356. Nitroglycerin, Desensitized With Not <40% Non-volatile Water Insoluble Phlegmatizer, By Mass

357. Nitroglycerin 100 Microg/ml In Acetonitrile. Short Expiry Date Due To Chemical Nature Of Component(s)

358. Nitroglycerin Mixture With >2% But Not >10% Nitroglycerin, By Mass, Desensitized [un3319] [flammable Solid]

359. Nitroglycerin, Desensitized With Not <40% Non-volatile Water Insoluble Phlegmatizer, By Mass [un0143] [explosive 1.1d, Poison]

360. Nitroglycerin, Solution In Alcohol, With >1% But Not >10% Nitroglycerin [un0144] [explosive 1.1d]

361. Nitroglycerin, Solution In Alcohol, With >1% But Not >5% Nitroglycerin [un3064] [flammable Liquid]

362. Nitroglycerin, Solution In Alcohol, With Not >1% Nitroglycerin [un1204] [flammable Liquid]

363. Trinitroglycerin Solution, 1 % (w/w) In Propylene Glycol, Ampule Of 1 Ml, Certified Reference Material

364. Trinitroglycerin Solution, 1 % (w/w) In Propylene Glycol, Ampule Of 5 X 0.2 Ml, Certified Reference Material

365. Trinitroglycerin Solution, 1000 Mug/ml In Acetonitrile, Ampule Of 1 Ml, Certified Reference Material

2.4 Create Date
2004-09-16
3 Chemical and Physical Properties
Molecular Weight 227.09 g/mol
Molecular Formula C3H5N3O9
XLogP31.6
Hydrogen Bond Donor Count0
Hydrogen Bond Acceptor Count9
Rotatable Bond Count5
Exact Mass227.00257875 g/mol
Monoisotopic Mass227.00257875 g/mol
Topological Polar Surface Area165 Ų
Heavy Atom Count15
Formal Charge0
Complexity219
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 14  
Drug NameMinitran
PubMed HealthNitroglycerin
Drug ClassesAntianginal, Cardiovascular Agent, Colorectal Agent, Coronary Vasodilator, Nitrate
Drug LabelNitroglycerin is a 1,2,3-propanetriol trinitrate, an organic nitrate whose structural formula isand whose molecular weight is 227.09. The organic nitrates are vasodilators, active on both arteries and veins.The MINITRAN (nitroglycerin) Transdermal...
Active IngredientNitroglycerin
Dosage FormFilm, extended release
RouteTransdermal
Strength0.1mg/hr; 0.6mg/hr; 0.4mg/hr; 0.2mg/hr
Market StatusPrescription
CompanyValeant Pharm North; Medicis

2 of 14  
Drug NameNitro-dur
PubMed HealthNitroglycerin Patch (Absorbed through the skin)
Drug ClassesAntianginal, Coronary Vasodilator
Drug LabelNitroglycerin is 1,2,3-propanetriol trinitrate, an organic nitrate whose structural formula is:and whose molecular weight is 227.09. The organic nitrates are vasodilators, active on both arteries and veins.The NITRO-DUR (nitroglycerin) Transdermal...
Active IngredientNitroglycerin
Dosage FormFilm, extended release
RouteTransdermal
Strength0.1mg/hr; 0.6mg/hr; 0.4mg/hr; 0.2mg/hr; 0.8mg/hr; 0.3mg/hr
Market StatusPrescription
CompanyMerck Sharp Dohme

3 of 14  
Drug NameNitroglycerin
PubMed HealthNitroglycerin
Drug ClassesAntianginal, Cardiovascular Agent, Colorectal Agent, Coronary Vasodilator, Nitrate
Drug LabelNitroglycerin is 1,2,3-propanetriol trinitrate, an organic nitrate whose structural formula is:and whose molecular weight is 227.09. The organic nitrates are vasodilators, active on both arteries and veins.The NITRO-DUR (nitroglycerin) Transdermal...
Active IngredientNitroglycerin
Dosage FormOintment; Spray, metered; Film, extended release; Injectable
RouteInjection; Sublingual; transdermal; Transdermal
Strength0.1mg/hr; 0.6mg/hr; 0.4mg/hr; 0.2mg/hr; 0.4mg/spray; 5mg/ml; 2%
Market StatusTentative Approval; Prescription
CompanyNoven; Hercon Pharm; Fougera; Luitpold; Mylan Technologies; Perrigo Israel

4 of 14  
Drug NameNitrolingual pumpspray
PubMed HealthNitroglycerin
Drug ClassesAntianginal, Cardiovascular Agent, Colorectal Agent, Coronary Vasodilator, Nitrate
Drug LabelNitroglycerin, an organic nitrate, is a vasodilator which has effects on both arteries and veins. The chemical name for nitroglycerin is 1,2,3-propanetriol trinitrate (C3H5N3O9). The compound has a molecular weight of 227.09. The chemical structure i...
Active IngredientNitroglycerin
Dosage FormSpray, metered
RouteSublingual
Strength0.4mg/spray
Market StatusPrescription
CompanyPohl Boskamp

5 of 14  
Drug NameNitromist
Drug LabelNitroglycerin, an organic nitrate, is a vasodilator which has effects on both arteries and veins. The chemical name for nitroglycerin is 1,2,3-propanetriol trinitrate (C3H5N3O9). The compound has a molecular weight of 227.09. The chemical structure i...
Active IngredientNitroglycerin
Dosage FormAerosol, metered
RouteSublingual
Strength0.4mg/spray
Market StatusPrescription
CompanyMist Pharms

6 of 14  
Drug NameNitrostat
Drug LabelNITROSTAT is a stabilized sublingual compressed nitroglycerin tablet that contains 0.3 mg, 0.4 mg , or 0.6 mg nitroglycerin; as well as lactose monohydrate, NF; glyceryl monostearate, NF; pregelatinized starch, NF; calcium stearate, NF powder; and si...
Active IngredientNitroglycerin
Dosage FormTablet
RouteSublingual
Strength0.4mg; 0.6mg; 0.3mg
Market StatusPrescription
CompanyPfizer Pharms

7 of 14  
Drug NameRectiv
Drug LabelNitroglycerin is 1,2,3,-propanetriol trinitrate, an organic nitrate whose structural formula is as follows:CH2-ONO2|CH-ONO2|CH2-ONO2and whose molecular weight is 227.09. RECTIV (nitroglycerin) Ointment 0.4% contains 0.4% nitroglycerin w/w (4mg...
Active IngredientNitroglycerin
Dosage FormOintment
RouteIntra-anal
Strength0.4%
Market StatusPrescription
CompanyForest Labs

8 of 14  
Drug NameMinitran
PubMed HealthNitroglycerin
Drug ClassesAntianginal, Cardiovascular Agent, Colorectal Agent, Coronary Vasodilator, Nitrate
Drug LabelNitroglycerin is a 1,2,3-propanetriol trinitrate, an organic nitrate whose structural formula isand whose molecular weight is 227.09. The organic nitrates are vasodilators, active on both arteries and veins.The MINITRAN (nitroglycerin) Transdermal...
Active IngredientNitroglycerin
Dosage FormFilm, extended release
RouteTransdermal
Strength0.1mg/hr; 0.6mg/hr; 0.4mg/hr; 0.2mg/hr
Market StatusPrescription
CompanyValeant Pharm North; Medicis

9 of 14  
Drug NameNitro-dur
PubMed HealthNitroglycerin Patch (Absorbed through the skin)
Drug ClassesAntianginal, Coronary Vasodilator
Drug LabelNitroglycerin is 1,2,3-propanetriol trinitrate, an organic nitrate whose structural formula is:and whose molecular weight is 227.09. The organic nitrates are vasodilators, active on both arteries and veins.The NITRO-DUR (nitroglycerin) Transdermal...
Active IngredientNitroglycerin
Dosage FormFilm, extended release
RouteTransdermal
Strength0.1mg/hr; 0.6mg/hr; 0.4mg/hr; 0.2mg/hr; 0.8mg/hr; 0.3mg/hr
Market StatusPrescription
CompanyMerck Sharp Dohme

10 of 14  
Drug NameNitroglycerin
PubMed HealthNitroglycerin
Drug ClassesAntianginal, Cardiovascular Agent, Colorectal Agent, Coronary Vasodilator, Nitrate
Drug LabelNitroglycerin is 1,2,3-propanetriol trinitrate, an organic nitrate whose structural formula is:and whose molecular weight is 227.09. The organic nitrates are vasodilators, active on both arteries and veins.The NITRO-DUR (nitroglycerin) Transdermal...
Active IngredientNitroglycerin
Dosage FormOintment; Spray, metered; Film, extended release; Injectable
RouteInjection; Sublingual; transdermal; Transdermal
Strength0.1mg/hr; 0.6mg/hr; 0.4mg/hr; 0.2mg/hr; 0.4mg/spray; 5mg/ml; 2%
Market StatusTentative Approval; Prescription
CompanyNoven; Hercon Pharm; Fougera; Luitpold; Mylan Technologies; Perrigo Israel

11 of 14  
Drug NameNitrolingual pumpspray
PubMed HealthNitroglycerin
Drug ClassesAntianginal, Cardiovascular Agent, Colorectal Agent, Coronary Vasodilator, Nitrate
Drug LabelNitroglycerin, an organic nitrate, is a vasodilator which has effects on both arteries and veins. The chemical name for nitroglycerin is 1,2,3-propanetriol trinitrate (C3H5N3O9). The compound has a molecular weight of 227.09. The chemical structure i...
Active IngredientNitroglycerin
Dosage FormSpray, metered
RouteSublingual
Strength0.4mg/spray
Market StatusPrescription
CompanyPohl Boskamp

12 of 14  
Drug NameNitromist
Drug LabelNitroglycerin, an organic nitrate, is a vasodilator which has effects on both arteries and veins. The chemical name for nitroglycerin is 1,2,3-propanetriol trinitrate (C3H5N3O9). The compound has a molecular weight of 227.09. The chemical structure i...
Active IngredientNitroglycerin
Dosage FormAerosol, metered
RouteSublingual
Strength0.4mg/spray
Market StatusPrescription
CompanyMist Pharms

13 of 14  
Drug NameNitrostat
Drug LabelNITROSTAT is a stabilized sublingual compressed nitroglycerin tablet that contains 0.3 mg, 0.4 mg , or 0.6 mg nitroglycerin; as well as lactose monohydrate, NF; glyceryl monostearate, NF; pregelatinized starch, NF; calcium stearate, NF powder; and si...
Active IngredientNitroglycerin
Dosage FormTablet
RouteSublingual
Strength0.4mg; 0.6mg; 0.3mg
Market StatusPrescription
CompanyPfizer Pharms

14 of 14  
Drug NameRectiv
Drug LabelNitroglycerin is 1,2,3,-propanetriol trinitrate, an organic nitrate whose structural formula is as follows:CH2-ONO2|CH-ONO2|CH2-ONO2and whose molecular weight is 227.09. RECTIV (nitroglycerin) Ointment 0.4% contains 0.4% nitroglycerin w/w (4mg...
Active IngredientNitroglycerin
Dosage FormOintment
RouteIntra-anal
Strength0.4%
Market StatusPrescription
CompanyForest Labs

4.2 Therapeutic Uses

Vasodilator Agents

National Library of Medicine's Medical Subject Headings online file (MeSH, 1999)


Nitroglycerin can provide dramatic relief of paroxysmal nocturnal dyspnea, probably as result of improved left ventricular function and reduced pulmonary arterial pressure. ... Topical application of ... ointment may provide ... cutaneous vasodilation, particularly in treatment of raynaud's disease and ... healing of trophic ulcers.

Gilman, A.G., L.S.Goodman, and A. Gilman. (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 7th ed. New York: Macmillan Publishing Co., Inc., 1985., p. 809


MEDICATION (VET): In cardiotonic mixtures, to directly depress arterial muscles.

Rossoff, I.S. Handbook of Veterinary Drugs. New York: Springer Publishing Company, 1974., p. 391


MEDICATION (VET): Has been used for asthma in dogs.

O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. 13th Edition, Whitehouse Station, NJ: Merck and Co., Inc., 2001., p. 1185


For more Therapeutic Uses (Complete) data for NITROGLYCERIN (17 total), please visit the HSDB record page.


4.3 Drug Warning

Untoward responses to therapeutic use of nitrites are almost all secondary to actions on cardiovascular system. Headache is common ... Transient episodes of dizziness, weakness, and other manifestations of cerebral ischemia associated with postural hypotension may develop. ... In many pt, particularly if standing immobile, and may ... progress to loss of consciousness. This reaction appears to be accentuated by alcohol. ... methemoglobinemia. /organic nitrites/

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill, 2001., p. 850


Contraindications: hypersensitivity to nitroglycerin or known idiosyncratic reaction to organic nitrates, hypotension or uncorrected hypovolemia, increased intracranial pressure, inadequate cerebral circulation, constrictive pericarditis, and pericardial tamponade.

Physicians Desk Reference p.1176-7 (1987)


Undesirable side effects from /nitroglycerin/ including: headaches, tachycardia, nausea, vomiting, apprehension, restlessness, muscle twitching, retrosternal discomfort, palpitations, dizziness, and abdominal pain. Paradoxical bradycardia and increased angina pectoris may accompany nitroglycerin-induced hypotension. ... With oral and/or topical use of nitroglycerin: cutaneous flushing, weakness, and occasionally, drug rash or exfoliative dermatitis.

Physicians Desk Reference p.1176-7 (1987)


In study groups, arterial partial pressure oxygen was decreased in most pt with coronary artery disease breathing room air in supine position. Clinical implications are discussed.

PMID:29482 KOPMAN ET AL; AM HEART J 96 (OCT): 444-7 (1978)


For more Drug Warnings (Complete) data for NITROGLYCERIN (14 total), please visit the HSDB record page.


4.4 Drug Indication

Nitroglycerin is indicated for various purposes. It is indicated to prevent and treat angina or chest pain due to cardiovascular disease, as well as to treat peri-operative hypertension or induce intra-operative hypotension. It is also indicated to treat acute heart failure in patients with myocardial infarction. In the ointment form, nitroglycerin is indicated to treat pain caused by anal fissures. The transdermal form is applied directly to the skin to prevent acute anginal attacks. The intravenous form is used off-label in emergency settings and is commonly used to treat acute coronary spasm caused by cocaine, hypertensive emergencies, as well as acute congestive heart failure exacerbations. Some other off-label uses of nitroglycerin include management of variceal hemorrhage, management of esophageal spasticity, and induction of uterine relaxation.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Nitroglycerin causes the relaxation of vascular smooth muscles, causing arteriolar and venous dilatation. It reduces cardiac preload and afterload and reduces coronary artery spasm, decreasing systemic vascular resistance as well as systolic and diastolic blood pressure. The reduction of cardiac work by nitroglycerin is thought to cause the most relief of anginal symptoms, with some contributions from arteriolar dilatation effects.


5.2 MeSH Pharmacological Classification

Vasodilator Agents

Drugs used to cause dilation of the blood vessels. (See all compounds classified as Vasodilator Agents.)


Explosive Agents

Substances that are energetically unstable and can produce a sudden expansion of the material, called an explosion, which is accompanied by heat, pressure and noise. Other things which have been described as explosive that are not included here are explosive action of laser heating, human performance, sudden epidemiological outbreaks, or fast cell growth. (See all compounds classified as Explosive Agents.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
NITROGLYCERIN
5.3.2 FDA UNII
G59M7S0WS3
5.3.3 Pharmacological Classes
Nitrates [CS]; Vasodilation [PE]; Nitrate Vasodilator [EPC]
5.4 ATC Code

C01DA02

S76 | LUXPHARMA | Pharmaceuticals Marketed in Luxembourg | Pharmaceuticals marketed in Luxembourg, as published by d'Gesondheetskeess (CNS, la caisse nationale de sante, www.cns.lu), mapped by name to structures using CompTox by R. Singh et al. (in prep.). List downloaded from https://cns.public.lu/en/legislations/textes-coordonnes/liste-med-comm.html. Dataset DOI:10.5281/zenodo.4587355


C - Cardiovascular system

C01 - Cardiac therapy

C01D - Vasodilators used in cardiac diseases

C01DA - Organic nitrates

C01DA02 - Glyceryl trinitrate


C - Cardiovascular system

C05 - Vasoprotectives

C05A - Agents for treatment of hemorrhoids and anal fissures for topical use

C05AE - Muscle relaxants

C05AE01 - Glyceryl trinitrate


5.5 Absorption, Distribution and Excretion

Absorption

Nitroglycerin is rapidly absorbed and is often used in emergency situations for this reason. After a sublingual dose of 0.5 mg of nitroglycerin, peak concentration was reached by an average of in 4.4 minutes after administration and was measured to be 2.56 ng/ml. Cmax following a 0.6mg dose of sublingual nitroglycerin was measured to be 2.1 ng/mL and AUC was 14.9 minutes, and Tmax was 7.2 minutes. Absolute bioavailability after the administration of sublingual nitroglycerin tablets is about 40%. The bioavailability of nitroglycerin depends on factors such as mucosal metabolism and hydration status, which both affect the absorption of sublingual drugs.


Route of Elimination

Metabolism is the main route by which nitroglycerin is eliminated from the body.


Volume of Distribution

The volume of distribution of nitroglycerin is 3 L/kg.


Clearance

The FDA label for the intravenous form of nitroglycerin estimates clearance to be 1 L/kg/min. Apparent clearance after a sublingual dose was measured to be 21.9 L/min in a pharmacokinetic study of 22 patients with ischemic heart disease and angina.


In human beings, peak concentrations of nitroglycerin are found in plasma within 4 min of sublingual administration.

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill, 2001., p. 849


volume of distribution 3.3 + or - 1.2 L/kg

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill, 2001., p. 1990


Nitroglycerin is readily absorbed through the mucous membranes, lungs, and intact skin. An average plasma concentration of 2.3 ng/ml was observed one hour after dermal application of 45 mg of nitroglycerin as an ointment. Nitroglycerine is 60% bound to plasma protein at plasma concentrations between 50 and 500 ng/mL.

Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1378


The mono and di-nitrate metabolites are glucuronidated and excreted in the urine and bile.

Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1378


For more Absorption, Distribution and Excretion (Complete) data for NITROGLYCERIN (7 total), please visit the HSDB record page.


5.6 Metabolism/Metabolites

The enzyme mitchochondrial aldehyde dehydrogenase is known to cause the bioactivation of nitroglycerin. Nitroglycerin is metabolized to nitrite, 1,2-glyceryl dinitrate, and 1,3 glyceryl dinitrate. Nitrite is then metabolized to nitric oxide or S-nitrosothiol. The 1,2-and 1,3-dinitroglycerols are less potent in strength than nitroglycerin, but they have longer half-lives, explaining some prolonged effects of nitrates. Both dinitrates are subsequently metabolized to mononitrates that are not active on the blood vessels, and to glycerol and carbon dioxide in the final step of metabolism.


... Glyceryl ... /mononitrate is/ major circulating ... /metabolite/ of nitroglycerin.

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill, 2001., p. 848


The metabolism of nitroglycerin... appears to involve reduced glutathione in a reaction catalyzed by an enzyme known as organic nitrate reductase, which is predominantly located in the soluble fraction of liver homogenate.

Zenz, C., O.B. Dickerson, E.P. Horvath. Occupational Medicine. 3rd ed. St. Louis, MO., 1994, p. 683


Nitroglycerin is degraded in the liver by reductive hydrolysis and partially in plasma by spontaneous hydrolysis... The major urinary metabolites include glyceryl mononitrate, 1,2-glyceryl dinitrate and 1,3-glyceryl dinitrate... Reactive hydrolysis in the liver by hepatic inorganic nitrate reductase leads to the formation of the free nitric oxide radical.

Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1378


Initial hydrolytic reduction by interaction of inorganic nitrate with reduced glutathione occurs both spontaneously and with enzymes, which can be extracted fron the soluble fraction of the liver.

Rom, W.N. (ed.). Environmental and Occupational Medicine. 2nd ed. Boston, MA: Little, Brown and Company, 1992., p. 1018


For more Metabolism/Metabolites (Complete) data for NITROGLYCERIN (6 total), please visit the HSDB record page.


5.7 Biological Half-Life

In a pharmacokinetic study, the plasma half-life of intravenously administered nitroglycerin was 2.8 0.9 minutes. The FDA label for the intravenous form of nitroglycerin indicates a similar plasma half-life of about 3 minutes. A pharmacokinetic study using sublingual nitroglycerin estimated the plasma half-life to be approximately 6 minutes. The elimination half-lives of 1,2- and 1,3-dinitroglycerin (metabolites of nitroglycerin)range between 32-26 minutes.


Half-life 2.3 + or - 0.6 minutes.

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill, 2001., p. 1990


The plasma half-life of nitroglycerin has been estimated at 1 to 3 minutes, representing the alpha distribution, and also at about 7.5 minutes.

Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1378


The elim half-life of 1,2- and 1,3-dinitroglycerin is 36 and 32 min, respectively.

Medical Economics Co; Physicians Desk Reference 56th ed p.2659 (2002)


5.8 Mechanism of Action

Nitroglycerin is converted by mitochondrial aldehyde dehydrogenase (mtALDH) to nitric oxide (NO), an active substance which then activates the enzyme guanylate cyclase. The activation of this enzyme is followed by the synthesis of cyclic guanosine 3',5'-monophosphate (cGMP), activating a cascade of protein kinase-dependent phosphorylation events in smooth muscles. This process eventually leads to the dephosphorylation of the myosin light chain of smooth muscles, causing relaxation and increased blood flow in veins, arteries and cardiac tissue.. The above processes lead to decreased work of the heart decreased blood pressure, relief of anginal symptoms, and increased blood flow to the myocardium.One in vitro study using mouse aorta suggests that nitric oxide (an activated metabolite of nitroglycerin) targets the natriuretic peptide receptors.


The drugs used to treat angina alleviate symptoms by increasing blood flow to the ischemic myocardium and/or by reducing myocardial oxygen requirements. ... /Nitrates/ reduce myocardial oxygen requirements through their effects on the systemic circulation. Their major systemic action is a reduction in venous tone, which leads to pooling of blood in peripheral veins, decreased venous return, and reduced ventricular volume and myocardial tension (preload). /Org nitrates/

American Medical Association, Department of Drugs. Drug Evaluations. 6th ed. Chicago, Ill: American Medical Association, 1986., p. 463


Although it predominately affects vascular smooth muscle /nitroglycerin/, the bronchioles, gastrointestinal tract (including biliary system), ureters, and uterus are affected. Free radicals of nitric oxide may activate guanylate cyclase, resulting in increased synthesis of cyclic GMP. Nitric oxide may combine with sulfhydryl groups in the endothelium and produce S-nitrosothiols, which stimulate guanylate cyclase production. N-acetyl-cycteine may enhance this process by providing a source of sulfhydryl groups. Cyclic GMP appears to reduce stored calcium and interfere with calcium-activated smooth muscle contractions.

Ellenhorn, M.J., S. Schonwald, G. Ordog, J. Wasserberger. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997., p. 1378


Organic nitrates... lead to the formation of the reactive free radical nitric oxide, which can activate guanylyl cyclase and increase the synthesis of cyclic GMP in smooth muscle and other tissues... A cyclic GMP-dependent protein kinase catalyzes the phosphorylation of various proteins in smooth muscle. Eventually, the light chain of myosin is dephosphorylated. Phosphorylation of the myosin chain regulates the maintenance of the contractile state in smooth muscle.

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill, 2001., p. 848


Nitrates also may alter the prostaglandin system by inhibiting thromboxane synthetase and permitting preferential formation of prostacyclin over thromboxane A2. Both of these two short-acting vasoactive substances are formed from prostaglandin precursors. Prostacyclin is a potent vasodilator which causes smooth muscle relaxation through phosphorylation of the myosin light chain kinase. This reduces its ability to to be activated by calciun and calmodulin.

Young, L.Y., M.A. Koda-Kimble (eds.). Applied Therapeutics. The Clinical Use of Drugs. 6th ed. Vancouver, WA., Applied Therapeutics, Inc. 1995., p. 13-7


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