Intravenous nitroglycerin. A review of pharmacology, indications, therapeutic effects and complications

Since the first description of nitroglycerin (NTG) as an antianginal agent one century ago, its use for this indication has become widely accepted. Recently, other uses have been proposed, including therapy of congestive heart failure, reduction of infarct size, treatment of heart failure following acute myocardial infarction (MI), and blood pressure reduction during either coronary artery bypass or general surgery. For many years, the only route for administration of nitroglycerin was sublingual, but in recent years other routes have gained acceptance, including cutaneous ointment, sustained-release oral forms, and even an inhalation aerosol. More recently, attention has focused on the intravenous (IV) route, with proponents extolling the ease and predictability of administration that make intravenous nitroglycerin (IVNTG) a valuable tool in a wide variety of clinical situations. Relatively few clinical studies and little critical commentary have been published on the use of IVNTG. We review critically recent pertinent literature and make general recommendations regarding current use.