From the Guidelines
Nitroglycerin paste is primarily indicated for the prevention and treatment of angina pectoris, as well as other conditions such as acute heart failure and hypertension during surgery, by dilating blood vessels and improving blood flow to the heart, as supported by the guidelines for the management of stable angina pectoris 1. The indications for nitroglycerin paste can be broken down into several key areas, including:
- Prevention and treatment of angina pectoris, a chest pain caused by reduced blood flow to the heart muscle
- Management of acute heart failure
- Control of hypertension during surgery
- Treatment of anal fissures, typically using a lower concentration of 0.2-0.4% The typical dose of nitroglycerin paste is 1-2 inches (1-2 grams) of 2% nitroglycerin ointment applied to non-hairy skin areas like the chest, abdomen, or thighs every 3-4 hours, as described in the guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction 1. It is essential to note that nitroglycerin paste should be used with caution, as it can cause potential side effects, including:
- Headache
- Dizziness
- Hypotension Additionally, tolerance may develop with continuous use, so a nitrate-free period of 10-12 hours (usually overnight) is often recommended to prevent this issue, as suggested by the guidelines for the management of stable angina pectoris 1. The use of nitroglycerin paste is also contrained in certain situations, such as after the use of sildenafil within the previous 24 hours or tadalafil within 48 hours, or with hypotension, as stated in the guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction 1.
From the FDA Drug Label
INDICATIONS AND USAGE: Nitroglycerin ointment is indicated for the prevention of angina pectoris due to coronary artery disease. The indications for nitroglycerin paste are:
- Prevention of angina pectoris due to coronary artery disease 2
From the Research
Indications for Nitroglycerin (Nitro) Paste
- Nitroglycerin paste is used for the treatment of angina pectoris, specifically for the relief of angina pain and improvement of exercise tolerance 3, 4, 5
- The primary mechanism of action is through peripheral venous dilatation, leading to a reduction in preload and left ventricular wall stress, as well as epicardial coronary artery dilatation and lowering of systemic blood pressure 5
- Nitroglycerin paste is often used in combination with other antianginal drugs, such as beta-blockers and calcium antagonists, for the treatment of stable angina pectoris 6, 7
- Ideal patient characteristics for nitrate therapy include:
- Predictably favourable response of chest pain to sublingual nitroglycerin
- Angina episodes suggestive of coronary vaso-constriction or spasm
- Left ventricular systolic dysfunction
- Symptoms of congestive heart failure (systolic or diastolic dysfunction) 4
- It is essential to consider the potential for nitrate tolerance and to follow a dosing regimen that avoids this issue, as it can result in loss of drug efficacy and increased long-term cardiovascular risk 3, 4, 5