From the Guidelines
In a clinic setting, nitroglycerin should not be withheld from a person with chest pain solely due to the absence of an intravenous (IV) line.
Administration of Nitroglycerin
Sublingual nitroglycerin, administered as a 0.4mg dose, may be given every 5 minutes as needed for up to 3 doses, to help alleviate angina symptoms 1.
Considerations for Further Treatment
If the patient's symptoms persist or worsen, further medical evaluation and treatment, including the consideration of IV access for potential administration of other medications such as morphine or beta blockers, should be promptly pursued 1.
Important Considerations
It is crucial to note that nitroglycerin is contraindicated with recent use of a phosphodiesterase inhibitor 1, and its use should be avoided in patients with initial systolic blood pressure less than 90 mm Hg or 30 mm Hg or more below baseline, or with marked bradycardia or tachycardia 1.
Key Points
- Nitroglycerin should not be withheld due to lack of IV access.
- Sublingual nitroglycerin can be given every 5 minutes as needed for up to 3 doses.
- Further medical evaluation and treatment should be considered if symptoms persist or worsen.
- Contraindications, such as recent phosphodiesterase inhibitor use, should be carefully evaluated.
From the Research
Administration of Nitroglycerin in a Clinic Setting
- The decision to withhold nitroglycerin from a person with chest pain in a clinic setting if an intravenous line (IV) is not available should be based on the patient's specific condition and medical history.
- According to the study 2, intravenous nitroglycerin can be safely and effectively administered in an emergency department setting for patients with ischemic chest pain unresponsive to sublingual nitroglycerin therapy.
- However, the study 2 does not directly address the situation where an IV line is not available.
- The study 3 suggests that high-dose sublingual nitroglycerin can be a safe alternative to IV nitroglycerin in certain situations, with a low incidence of hypotension.
- Another study 4 found that adverse events after prehospital nitroglycerin administration were rare, and that having an existing IV access was associated with fewer adverse events.
- The study 5 provides an overview of the use of nitroglycerin in the emergency department, including its indications, mechanism of action, and potential adverse effects.
- The study 6 highlights the importance of patient education and proper use of sublingual nitroglycerin for angina self-management.
Considerations for Administration
- The patient's systolic blood pressure (SBP) and heart rate should be taken into account when deciding whether to administer nitroglycerin 3, 4.
- The presence of an IV line may be associated with fewer adverse events 4.
- Patient demographics, such as age and race, may also be relevant factors to consider 4.
- The studies 2, 5, 3, 4 suggest that nitroglycerin can be a safe and effective treatment for chest pain in certain situations, but the decision to administer it should be made on a case-by-case basis.