2.6.1 Nitrates

Glyceryl trinitrate
  • Tablets 500 micrograms (£7.05 = 100)
  • Spray 400 micrograms (£1.82 = pump spray)
  • Injection 5mg in 5ml, 10mg in 10ml, 50mg in 50ml

Indications

Notes

  1. GTN 500 microgram tablets should be prescribed in quantities of 100 for the patient to keep in the unopened bottle until needed. Once open, the shelf life of the tablets is 8 weeks.
  2. The spray may be more appropriate for those who only require GTN occasionally, as there are no shortened shelf life considerations.
Isosorbide mononitrate
  • Chemydur XL®, Monomil XL® modified release tablets 60mg (£3.49)
  • Tablets 10mg, 20mg, 40mg (£2.19 = 40mg twice daily)

Indications

  • Angina (prophylaxis)
  • Adjunct in congested heart failure

Notes

  1. NICE guidance for stable angina recommends isosorbide mononitrate long acting is used only if beta blockers and calcium channel blockers are contraindicated or not tolerated.
  2. If initiating isosorbide mononitrate in nitrate naïve patients, commence with 30mg XL for the first 2-4 days (Chemydur® 60XL and Monomil® XL 60 tablets are scored and can be halved), or convert to XL product from standard release once tolerated. Prescribe the tablets to be taken 8 hours apart rather than 12 hours to reduce the potential for nitrate tolerance.
  3. Sustained release isosorbide mononitrate should be prescribed by brand name only. Generic prescribing may result in higher costs than the formulary choice.
Isosorbide dinitrate
  • Injection 25mg in 50ml (half strength), 50mg in 50ml

 

Home > Formulary > Chapters > 2. Cardiovascular > 2.6 Nitrates, calcium-channel blockers, and other antianginal drugs > 2.6.1 Nitrates

 

  • First line
  • Second line
  • Specialist
  • Hospital