NitroglycerinLexi-Drugs Online

Medication Safety Issues

Sound-alike/look-alike issues:

Nitroglycerin may be confused with nitroprusside

Nitro-Bid® may be confused with Nicobid®

Nitroderm may be confused with NicoDerm®

Nitrol® may be confused with Nizoral®

Nitrostat® may be confused with Nilstat®, nystatin

Nitroglycerin transdermal patches should be removed prior to defibrillation or MRI study.

International issues:

Nitrocor® [Chile and Italy] may be confused with Natrecor® which is a brand name for nesiritide in the U.S.

Nitrocor® [Chile and Italy] may be confused with Nutracort®which is a brand name for hydrocortisone in the U.S.

Nitro-Dur® may be confused with Nitrocor® [Chile and Italy]

Pronunciation

(nye troe GLI ser in)

U.S. Brand Names

Minitran™; Nitrek® [DSC]; Nitro-Bid®; Nitro-Dur®; Nitrolingual®; NitroQuick®; Nitrostat®; NitroTime®

Canadian Brand Names

Gen-Nitro; Minitran™; Nitro-Dur®; Nitroglycerin Injection, USP; Nitrol®; Nitrostat™; Rho®-Nitro; Transderm-Nitro®; Trinipatch® 0.2; Trinipatch® 0.4; Trinipatch® 0.6

Pharmacologic Category

Vasodilator

Use: Labeled Indications

Treatment of angina pectoris; I.V. for congestive heart failure (especially when associated with acute myocardial infarction); pulmonary hypertension; hypertensive emergencies occurring perioperatively (especially during cardiovascular surgery)

Use: Unlabeled/Investigational

Esophageal spastic disorders (sublingual)

Dosing: Adults

Note: Hemodynamic and antianginal tolerance often develop within 24-48 hours of continuous nitrate administration. Nitrate-free interval (10-12 hours/day) is recommended to avoid tolerance development; gradually decrease dose in patients receiving NTG for prolonged period to avoid withdrawal reaction.

Angina/coronary artery disease:

Oral: 2.5-9 mg 2-4 times/day (up to 26 mg 4 times/day)

I.V.: 5 mcg/minute, increase by 5 mcg/minute every 3-5 minutes to 20 mcg/minute. If no response at 20 mcg/minute increaseby 10 mcg/minute every 3-5 minutes, up to 200 mcg/minute.

Topical ointment: Include a nitrate free interval, ∼10 to 12 hours; Apply 0.5†to 2†every 6 hours with a nitrate � �free interval.

Topical patch, transdermal: 0.2-0.4 mg/hour initially and titrate todoses of 0.4-0.8 mg/hour. Tolerance is minimized by using a patch-on period of 12-14 hours and patch-off period of 10-12 hours.

Sublingual: 0.2-0.6 mg every 5 minutes for maximum of 3 doses in15 minutes; may also use prophylactically 5-10 minutes prior to activities which may provoke an attack.

Esophageal spastic disorders (unlabeled use): 0.3-0.4 mg 5minutes before meals

Translingual: 1-2 sprays into mouth under tongue every 3-5 minutes for maximum of 3 doses in 15 minutes, may also be used 5-10 minutes prior to activities which may provoke anattack prophylactically.

Dosing: Elderly

Refer to adult dosing.

Dosing: Pediatric

Pulmonary hypertension: I.V. Continuous infusion: Children: Start0.25-0.5 mcg/kg/minute and titrate by 1 mcg/kg/minute at 20- to 60-minute intervals to desired effect; usual dose: 1-3 mcg/kg/minute; maximum: 5 mcg/kg/minute

Note: Hemodynamic and antianginal tolerance often develop within 24-48 hours of continuous nitrate administration.

Calculations

Nitroglycerin Nitroglycerin: Pediatrics

Administration: I.V.

I.V. must be prepared in glass bottles and use special sets intended for nitroglycerin. Glass I.V. bottles and administrationsets provided by manufacturer.

Administration: I.V. Detail

Nitroglycerin can be absorbed by plastic (polyvinyl chloride) tubing or containers. Infusion pump may not infuse accurately with different tubing. Be alert to potential for unregulated flow.

pH: 3.0-6.5

Administration: Oral Sublingual: Do not crush sublingual product (tablet). Place under

tongue and allow to dissolve.

Translingual spray: Do not shake container. Release spray onto orunder tongue. Do not rinse the mouth for at least 5-10 minutes. Priming sprays should be directed away from patient and others. The end of the pump should be covered by the fluid in the bottle.

Nitrolingual®: Prime prior to first use (5 sprays into the air). If unused for 6 weeks, a single priming spray shouldbe completed.

Storage

Doses should be made in glass bottles, Excel® or PAB® containers. Adsorption occurs to soft plastic (eg, PVC). Nitroglycerin diluted in D5W or NS in glass containers is physically and chemically stable for 48 hours at room temperatureand 7 days under refrigeration. In D5W or NS in Excel®/PAB® containers it is physically and chemically stable for 24 hours atroom temperature and 14 days under refrigeration. Premixed bottles are stable according to the manufacturer's expiration dating. Store sublingual tablets and ointment in tightly closed containers at 15°C to 30°C. Store spray and transdermal patch at 25°C; excursions permitted to 15°C to 30°C (59°F to 86°F).

Reconstitution

Standard diluent: 50 mg/250 mL D5W; 50 mg/500 mL D5W.

Minimum volume: 100 mg/250 mL D5W; concentration should not exceed 400 mcg/mL.

Compatibility

Stable in D5LR, D51/2NS, D5NS, LR, 1/2NS; variable stability

(consult detailed reference) in D5W, NS.

Y-site administration: Compatible: Alatrofloxacin, amiodarone, amphotericin B cholesteryl sulfate complex, atracurium, cisatracurium, diltiazem, dobutamine, dobutamine with dopamine, dobutamine with lidocaine, dobutamine with sodium nitroprusside, dopamine, dopamine with lidocaine, dopamine with sodium nitroprusside, epinephrine, esmolol, famotidine, fentanyl, fluconazole, furosemide, gatifloxacin, haloperidol,heparin, hydromorphone, inamrinone, insulin (regular), labetalol, lidocaine, lidocaine with sodium nitroprusside, linezolid, lorazepam, midazolam, milrinone, morphine, nicardipine, norepinephrine, pancuronium, propofol,

ranitidine, remifentanil, sodium nitroprusside, streptokinase, tacrolimus, theophylline, thiopental, vecuronium, warfarin. Incompatible: Alteplase, levofloxacin. Variable (consult detailed reference): Hydralazine.

Compatibility in syringe: Compatible: Heparin.

Compatibility when admixed: Dose is variable and may require titration, therefore, it is not advisable to mix with other agents. Compatible: Alteplase, aminophylline, dobutamine, dopamine, enalaprilat, furosemide, lidocaine, verapamil. Incompatible: Hydralazine, phenytoin. Variable (consult detailed reference): Bretylium, dobutamine with sodium nitroprusside.

Contraindications

Hypersensitivity to organic nitrates; hypersensitivity to isosorbide, nitroglycerin, or any component of the formulation; concurrent use with phosphodiesterase-5 (PDE-5) inhibitors (sildenafil, tadalafil, or vardenafil); angle-closure glaucoma (intraocular pressure may be increased); head trauma or cerebral hemorrhage (increase intracranial pressure); severe anemia; allergy to adhesive (transdermal product)

Additional contraindications for I.V. product: Hypotension; uncorrected hypovolemia; inadequate cerebral circulation; constrictive pericarditis; pericardial tamponade

Allergy Considerations

Nitrate Allergy

Warnings/Precautions

Concerns related to adverse effects:

• Hypotension/bradycardia: Severe hypotension can occur; paradoxical bradycardia and increased angina pectoris can accompany hypotension. Orthostatic hypotension can also occur; ethanol can accentuate this. Use with caution in volume depletion, hypotension, and right ventricular infarctions.

Disease-related concerns:

• Hypertrophic cardiomyopathy: Use with caution in patientswith hypertrophic cardiomyopathy; nitrates may reduce preload, exacerbating obstruction and cause hypotension and/or worsening of heart failure.

Concurrent drug therapy issues:

• PDE-5 inhibitors: Avoid concurrent use with PDE-5 inhibitors (eg, sildenafil, tadalafil, vardenafil).

Special populations:

• Pediatrics: Safety and efficacy have not been establishedin children.

Dosage form specific issues:

• Long-acting agents: Avoid use of long-acting agents in acute MI or HF; cannot easily reverse if adverse events develop.

• Transdermal patches: Patches should be removed prior to defibrillation or MRI study.

Other warnings/precautions:

• Tolerance: Appropriate dosing is needed to minimize tolerance development.

Geriatric Considerations

Caution should be used when using nitrate therapy in the elderly due to hypotension. Hypotension is enhanced in the elderly due todecreased baroreceptor response, decreased venous tone, and oftenhypovolemia (dehydration) or other hypotensive drugs.

Pregnancy Risk Factor

C

Lactation

Excretion in breast milk unknown/use caution

Adverse Reactions

Frequency not always defined:

Cardiovascular: Hypotension (4%), postural hypotension, crescendo angina (2%), tachycardia, flushing, peripheral edema

Central nervous system: Headache (most common; 50% to 63%), lightheadedness (6%), syncope (4%), dizziness

Gastrointestinal: Nausea, vomiting, bowel incontinence, xerostomia

Genitourinary: Urinary incontinence

Ocular: Blurred vision

Miscellaneous: Diaphoresis

<1% (Limited to important or life-threatening): Allergic reactions, application site irritation (patch), cardiovascular collapse, exfoliative dermatitis, methemoglobinemia (rare; overdose), pallor, palpitation, rash, rebound hypertension, restlessness, shock, vertigo, weakness

Drug Interactions

Alteplase: Nitroglycerin may decrease the serum concentration of Alteplase. Risk C: Monitor therapy

Amifostine: Antihypertensives may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, antihypertensive medications should be withheld for 24 hours prior to amifostine administration. If antihypertensive therapy can not be withheld, amifostine should not be administered. Risk D: Consider therapy modification

Diazoxide: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy

Heparin: Nitroglycerin may diminish the anticoagulant effect of Heparin. Nitroglycerin may decrease the serum concentration of Heparin. Risk C: Monitor therapy

Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the vasodilatory effect of Vasodilators (Organic Nitrates). Risk X: Avoid combination

Prostacyclin Analogues: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy

RiTUXimab: Antihypertensives may enhance the hypotensive effect of RiTUXimab. Risk D: Consider therapy modification

Rosiglitazone: Vasodilators (Organic Nitrates) may enhance the adverse/toxic effect of Rosiglitazone. Specifically, a

greater risk of myocardial ischemia was reported for users ofthis combination in a meta-analysis. Management: Consider alternatives to this combination when possible. Rosiglitazoneprescribing information states that the combination of rosiglitazone and a nitrate is not recommended. Risk D: Consider therapy modification

Yohimbine: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy

Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid ethanol (may increase the hypotensive effects of nitroglycerin). Monitor.

Herb/Nutraceutical: Avoid bayberry, blue cohosh, cayenne, ephedra, ginger, ginseng (american), kola, licorice (may worsen hypertension). Avoid black cohosh, California poppy, coleus, golden seal, hawthorn, mistletoe, periwinkle, quinine, shepherd's purse (may cause hypotension).

Monitoring Parameters

Blood pressure, heart rate

Nursing: Physical Assessment/Monitoring

Assess potential for interactions with other pharmacological agents patient may be taking (eg, heparin, ergot alkaloids, sildenafil, tadalafil, or vardenafil). See Administration specifics for different formulations. Evaluate therapeutic effectiveness (cardiac status) and adverse response (eg, hypotension, arrhythmias, CNS changes, GI disturbances). Dose should be reduced gradually when discontinuing after long-term therapy. Teach patient proper use (according to purpose and formulation), possible side effects/appropriate interventions (eg, drug-free intervals; removes transdermal patches for specific period of time), and adverse symptoms to report.

Patient Education

Do not take any new medication during therapy unless approved by prescriber. Take as per directions (see below). Do not change brands without consulting prescriber. Do not discontinue abruptly. Keep medication in original container, tightly closed. If anginal chest pain is unresolved in 15 minutes, seek emergencymedical help at once. Daily use may cause dizziness or lightheadedness (use caution when driving or engaging in hazardous activities until response to drug is known); headache (consult prescriber for approved analgesic); hypotension (use care when changing position from sitting or lying to standing, when climbing stairs or when engaging in tasks that are potentially hazardous until response to drug is known); GI disturbances (small, frequent meals, frequent mouth care, chewinggum, or sucking lozenges may help). Report acute headache, rapid heartbeat, unusual restlessness or dizziness, muscular weakness, or blurred vision or seeing abnormal colors. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Oral: Take as directed. Do not chew or swallow sublingual tablets; allow to dissolve under tongue. Sit down before using sublingual or buccal tablet or spray form. Do not chew or crush extended release capsules; swallow with 8 oz of water.

Spray: Follow exact instructions in product insert. Spray directly on mucous membranes; do not inhale.

Topical: Spread prescribed amount thinly on applicator; rotate application sites.

Transdermal: Use as directed; place on hair-free area of skin, rotate sites (usually, patches will be removed for a period each day)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, extended release: 2.5 mg, 6.5 mg, 9 mg

Nitro-Time®: 2.5 mg, 6.5 mg, 9 mg

Infusion [premixed in D5W]: 25 mg (250 mL) [0.1 mg/mL]; 50 mg (250 mL) [0.2 mg/mL]; 50 mg (500 mL) [0.1 mg/mL]; 100 mg (250mL) [0.4 mg/mL]; 200 mg (500 mL) [0.4 mg/mL]

Injection, solution: 5 mg/mL (5 mL, 10 mL) [contains ethanol and propylene glycol]

Ointment, topical:

Nitro-Bid®: 2% [20 mg/g] (1 g, 30 g, 60 g)

Solution, translingual [spray]:

Nitrolingual®: 0.4 mg/metered spray (4.9 g) [contains ethanol 20%; 60 metered sprays]; (12 g) [contains ethanol 20%; 200 metered sprays]; (16.9 g) [contains ethanol 20%; 260 metered sprays]

Tablet, sublingual: 0.3 mg, 0.4 mg, 0.6 mg

NitroQuick®, Nitrostat®: 0.3 mg, 0.4 mg, 0.6 mg

Transdermal system [once-daily patch]: 0.1 mg/hour (30s); 0.2 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/hour (30s)

Minitranâ„¢: 0.1 mg/hour (30s); 0.2 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/hour (30s)

Nitrek®: 0.2 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/hour (30s) [DSC]

Nitro-Dur®: 0.1 mg/hour (30s); 0.2 mg/hour (30s); 0.3 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/hour (30s); 0.8 mg/hour (30s)

Generic Available

Yes: Capsule, injection, patch, tablet

Pricing: U.S. (www.drugstore.com)

Capsule, controlled release (Nitroglycerin CR)

2.5 mg (30): $13.99

6.5 mg (30): $13.38

9 mg (30): $14.99

Ointment (Nitro-Bid)

2% (60): $19.99

2% (60): $27.95

Patch, 24-hour (Minitran)

0.1 mg/hour (30): $78.98

0.2 mg/hour (30): $79.09

0.4 mg/hour (30): $87.72

0.6 mg/hour (30): $94.88

Patch, 24-hour (Nitro-Dur)

0.1 mg/hour (30): $88.28

0.2 mg/hour (30): $99.72

0.3 mg/hour (30): $98.77

0.4 mg/hour (30): $110.57

0.6 mg/hour (30): $109.47

0.8 mg/hour (30): $110.56

Patch, 24-hour (Nitroglycerin)

0.1 mg/hour (30): $25.99

0.2 mg/hour (30): $28.99

0.4 mg/hour (30): $36.99

0.6 mg/hour (30): $39.99

Solution (Nitrolingual)

0.4 mg/spray (4.9): $113.87

0.4 mg/spray (12): $184.92

Sublingual (Nitroglycerin)

0.3 mg (100): $13.99

0.4 mg (100): $14.99

Sublingual (NitroQuick)

0.3 mg (100): $9.99

0.4 mg (25): $7.99

0.6 mg (100): $8.99

Sublingual (Nitrostat)

0.3 mg (100): $27.76

0.4 mg (25): $19.31

0.4 mg (100): $29.89

Sublingual (NitroTab)

0.4 mg (25): $8.99

Mechanism of Action

Works by relaxation of smooth muscle, producing a vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins. Primarily reduces cardiac oxygen demand by decreasing preload (left ventricular end-diastolic pressure); maymodestly reduce afterload; dilates coronary arteries and improvescollateral flow to ischemic regions

Pharmacodynamics/Kinetics

Onset of action: Sublingual tablet: 1-3 minutes; Translingual spray: 2 minutes; Sustained release: 20-45 minutes; Topical: 15-60 minutes; Transdermal: 40-60 minutes; I.V. drip: Immediate

Peak effect: Sublingual tablet: 4-8 minutes; Translingual spray: 4-10 minutes; Sustained release: 45-120 minutes; Topical: 30-120 minutes; Transdermal: 60-180 minutes; I.V.drip: Immediate

Duration: Sublingual tablet: 30-60 minutes; Translingual spray: 30-60 minutes; Sustained release: 4-8 hours; Topical: 2-12 hours; Transdermal: 18-24 hours; I.V. drip: 3-5 minutes

Protein binding: 60%

Metabolism: Extensive first-pass effect

Half-life elimination: 1-4 minutes

Excretion: Urine (as inactive metabolites)

Related Information

Hemodynamic Support, Intravenous Hypertension Nitrates

Pharmacotherapy Pearls

I.V. preparations contain alcohol and/or propylene glycol; may need to use nitrate-free interval (10-12 hours/day) to avoid tolerance development. Tolerance may possibly be reversed with acetylcysteine; gradually decrease dose in patients receiving NTGfor prolonged period to avoid withdrawal reaction.

Concomitant use of sildenafil (Viagra®) or other phosphodiesterase-5 enzyme inhibitors (PDE-5) may precipitate acute hypotension, myocardial infarction, or death. Nitrates usedin right ventricular infarction may induce acute hypotension. Nitrate use in severe pericardial effusion may reduce cardiac filling pressure and precipitate cardiac tamponade. In the management of heart failure, the combination of isosorbide dinitrate and hydralazine confers beneficial effects on disease progression and cardiac outcomes.

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation).

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause dizziness

Mental Health: Effects on Psychiatric Treatment

None reported, but monitor for hypotension if receiving a psychotropic

Cardiovascular Considerations

Nitrates improve the balance between myocardial oxygen supply anddemand, primarily by decreasing oxygen demand. Nitrates decreasesmyocardial oxygen demand by reducing preload via dilation of peripheral veins. Nitrates improve myocardial oxygen supply by dilating epicardial coronary arteries and collateral vessels, leaving resistance vessels alone. Nitrates are unlikely to inducea coronary steal syndrome. Nitrates improve exercise tolerance instable angina patients. An adequate nitroglycerin-free period must be provided with all nitrate products to prevent nitrate tolerance from developing. In the treatment of unstable angina/non-ST-segment elevation MI, I.V. NTG is indicated for immediate relief of ischemia when sublingual nitroglycerin (tablet or spray) and intravenous beta-blocker have failed. I.V. NTG may also be of benefit in nonhypotensive high-risk patients. Caution should be observed if administering nitrates to individuals who are volume-depleted or are experiencing a right ventricular infarction. Additionally, nitrates should not be given to an individual who has received a phosphodiesterase-5 enzyme inhibitor within the past 24 hours. In a stabilized patient, intravenous nitroglycerin should be converted within 24 hours to a nonparenteral alternative in a regimen that is designed to prevent tolerance.

The 2004 STEMI guidelines suggest that healthcare providers should instruct patients, with sublingual nitroglycerin on hand, to take one dose sublingually in response to chest discomfort/pain. If chest pain is unimproved or worsening 5 minutes after the dose has been taken, the patient or family should call an ambulance. Use I.V. nitroglycerin for relief of ongoing ischemic discomfort (if S.L. nitroglycerin has been ineffective), control of hypertension, or management of pulmonary

congestion. Nitrates should not be used if hypotension limits theaddition of a beta-blocker.

Anesthesia and Critical Care Concerns/Other Considerations

Nitroglycerin 5 mg/mL contains propylene glycol 518 mg/mL (30% v/v).

In the treatment of unstable angina/non-ST-segment elevation MI, nitroglycerin (sublingual tablet or spray), followed by intravenous administration, is recommended for immediate relief of ischemia and associated symptoms. Note that nitrate use may result in significant hypotension in individuals who are volume depleted.

Nitrate use in right ventricular infarction may induce acute hypotension. Nitrate use in severe pericardial effusion may reduce cardiac filling pressure and precipitate cardiac tamponade.

Index Terms

Glyceryl Trinitrate; Nitroglycerol; NTG

References

Antman EM, Anbe SC, Alpert JS, et al, “ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction - Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction),†�Circulation, 2004, 110(5):588-636. Available at: http://www.circulationaha.org/cgi/content/full/110/5/588. Last accessed October 26, 2004. [PubMed 15289388]

Braunwald E, Antman EM, Beasley JW, et al, “ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction - Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With UnstableAngina),†� J Am Coll Cardiol, 2002, 40(7):1366-74. Available at: http://www.acc.org/clinical/guidelines/unstable/incorporated/index.htm. Accessed May 20, 2003. [PubMed 12383588]

Cheitlin MD, Hutter AM Jr, Brindis RG, et al, “ACC/AHA Expert Consensus Document. Use of Sildenafil (Viagra®) in Patients WithCardiovascular Disease. American College of Cardiology/American Heart Association,†� J Am Coll Cardiol, 1999, 33(1):273-82. [PubMed 9935041]

Erstad BL and Barletta JF, “Treatment of Hypertension in the Perioperative Patient,†� Ann Pharmacother, 2000, 34(1):66-79. [PubMed 10669188]

Gibbons RJ, Abrams J, Chatterjee K, et al, “ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina - Summary Article: A Report of the American Collegeof Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina),†� J Am Coll Cardiol, 2003, 41(1):159-68. Available at: http://http://www.acc.org/clinical/guidelines/stable/stable_clean.pdf. Accessed May 5, 2004.[PubMed 12570960]

International Brand Names

Anginine (AU); Angised (HR, SG); Deponit (CL, DE, HU, LU, MY, PE,PH); Deponit NT (HK); Deponit TTS 10 (IL); Deponit TTS 5 (IL); Diafusor (LU); Epinitril (FR); Glytrin Spray (NZ); Herzer (JP); Lenitral (HK); Lycinate (AU); Millisrol (JP); Minitran (AR, AU, CR, DO, GR, GT, HN, LU, PA, PH, PY, SV, UY, VE); Myovin (IN); Natispray (LU); Nit-Ret (CZ); Nitracor (PL); Nitradisc (BR, HK, LU, MX, PE, PT); Nitradisc TTS (GR); Nitriderm TTS (FR); Nitro

(FI, HU); Nitro Dur TTS (CH); Nitro Mack (LU); Nitro Mack Retard (AE, AT, BH, CH, CY, CZ, EG, GR, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Nitro Pohl (HU); Nitro-Bid (AU, MY); Nitro-Dur (ES, HU, IT, NO, PL, PT); Nitro-Dur 10 (IL); Nitro-M-Bid (BE); Nitro-Mack (PL); Nitro-Pflaster (DE); Nitro-Pflaster-ratiopharm (LU); Nitrobaat (BE, NL); Nitrocard (PL); Nitrocerin (GR); Nitrocine (TW); Nitrocine 5 (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Nitrocontin (BF, BJ, CI, ET, GH, GM,GN, IE, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW); Nitrocontin Continus (AE, BH, CY, EG, IL, IN, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Nitrocor (IT, PT); Nitroderm TTS (AE, AR, AT, BB, BE, BF, BH, BJ, BM, BR, BS, BZ, CH, CI, CY, DE, EC, EG, ES, ET, GH, GM, GN, GY, HR, HU, IL, IN, IQ, IR, IT, JM, JO, KE, KW, LB, LR, LU, LY, MA, ML, MR, MU, MW, MY, NE, NG, NZ, OM, PK, PL, PT, QA, SA, SC, SD, SL, SN, SR, SY, TH, TN, TT, TW, TZ, UG, YE, ZA, ZM, ZW); Nitroderm TTS Ext (CZ); Nitroderm TTS-5 (CR, DO, GT, HN, NI, PA, SV); Nitrodisc (BB, BM, BS, BZ, GY, JM, MY, SR, TT); Nitrodor (CN); Nitrodyl (GR, LU); Nitrodyl TTS (GR); Nitroglycerinum (PL); Nitroglycerinum prolongatum (PL); Nitrokaf Forte (ID); Nitrokaf Retard (ID); Nitrol (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, PH, QA, SA, SY, YE); Nitrolingual (AT, BE, CH, DE, DK, GB, GR, HK, HN, HU, IE, LU, NL, PH, PT, SE); Nitrolingual Spray (KP, NZ, PH); Nitromack Retard (PY); Nitromex (DK, FI, NO, SE); Nitromint (HN, HU, PL, TH); Nitromint Aerosol (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW); Nitromint Retard (AE, BB, BH, BM, BS, BZ, CY, EG, GY, IL, IQ, IR, JM, JO, KW, LB, LY, OM, QA, SA, SR, SY, TT, YE); Nitronal (FR, IE); Nitronal Aqueous (PH); Nitronal Spray (FR); Nitrong (BE, FI, HN, LU); Nitrong Retard (AT, GR); Nitroplast (ES); Nitropront (FI); Nitrostat (HK, PH, TW); Nitrozell Retard (AT, NL); Nysconitrine (BE, LU); Percutol Oint. (GB, IE); Perlinganit (HU, KP, LU, PL); Ratiopharm (DE); Rectogesic (AU, FR); Suscard (GB, IE); Sustac (AE, BB, BH, BM, BS, BZ, CY, EG, GY, HR, HU, IL, IQ, IR, JM, JO, KW, LB, LY, OM, QA, SA, SR, SY, TT, YE); Sustonit (PL); Transiderm Nitro (AU, FI,HN, IE, NL, NO, SE); Trimonit (PL); Trinipatch (LU); Trinter (GB,IE); Venitrin (IT); Willlong (LU)

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