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

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 modified release for the first 2-4 days (some tablets are scored and can be halved), or convert to a modified release 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. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Isosorbide dinitrate
  • Injection 25mg in 50ml (half strength), 50mg in 50ml

 

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