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Glyceryl TNT (Glyceryl Trinitrate)
Glyceryl TNT Information
Glyceryl TNT is indicated for the treatment of acute attacks of angina pectoris including variant angina and for the prophylaxis of such attacks.
Glyceryl TNT Warnings
Glyceryl TNT should be used with caution in patients with cerebrovascular disease since symptoms may be precipitated by hypotension. Glyceryl TNT may worsen hypoxaemia in patients with lung disease or cor pulmonale. Arterial hypotension with bradycardia may occur in patients with myocardial infarction; this is thought to be reflexly mediated. The use of Glyceryl TNT could theoretically compromise myocardial blood supply in patients with left ventricular hypertrophy associated with aortic stenosis because of the detrimental effects of tachycardia and decreased aortic diastolic pressure.
Detailed haemodynamic studies in a small number of patients with valvular aortic stenosis with and without concomitant significant coronary artery disease studied in the supine position have not shown adverse effects with sublingual glyceryl trinitrate. However it seems prudent to be cautious in treating ambulant patients with the combination of angina and moderate to severe valvular aortic stenosis.
DRUG INTERACTIONS : The risk of hypotension and syncope with use of Glyceryl TNT may be enhanced by alcohol. The possibility of tolerance to the effects of Glyceryl TNT should be considered when used in conjunction with long-acting nitrate preparations. No data are available on the use of Glyceryl TNT during human pregnancy, or on the excretion of glyceryl trinitrate or its metabolites in human milk. CONTRA-INDICATIONS : Glyceryl TNT is contra-indicated in angina caused by hypertrophic obstructive cardiomyopathy as it may exaggerate outflow obstruction. Glyceryl TNT should not be used in patients with cerebral haemorrhage or head trauma.
Glyceryl TNT Side effects
The dose of Glyceryl TNT may be limited by vascular headaches. Other side effects are facial flushing, tachycardia, light-headedness, dizziness, halitosis, hypotension, syncope and rarely bradycardia. Large doses may cause vomiting, cyanosis, restlessness, methaemoglobinaemia and impairment of respiration. Headache and/or light-headedness persisting after relief of angina may be minimised by removing the Glyceryl TNT Tablets before it has completely dissolved. Glyceryl TNT-induced hypotension may cause cerebral ischaemia. Glyceryl TNT occasionally causes a drug rash.
Glyceryl TNT Overdose
In the case of ingestion, all that is usually required is supportive treatment of the cardiovascular and respiratory systems. The patient should be nursed head-down if hypotensive. Arterial blood gas estimation should be performed and if there is acidosis or the patient is clinically cyanosed, then severe methaemoglobinaemia must be assumed. Oxygen therapy should be given with 1 to 2 mg/kg bodyweight of intravenous Methylene Blue over 5 minutes. It should be stored below 25°C and protected from light. Discard any remaining tablets 8 weeks after first opening the container.
Glyceryl TNT Usage guidelines
Glyceryl TNT must be placed under the tongue (administered sublingually) and retained in the mouth until dissolved or discarded. Treatment of acute attacks: When angina starts 0.5mg or 0.6mg glyceryl trinitrate (one tablet) should be taken every 3 minutes until cessation of pain or limiting side effects, such as headache or light-headedness supervene. The patient should preferably rest in the sitting position because of the risk of symptomatic postural hypotension. Prophylaxis: One tablet may be used prior to activity which is likely to precipitate angina pectoris. Pulmonary oedema: In the treatment of pulmonary oedema doses ranging between 0.8 mg and 2.4 mg of glyceryl trinitrate has been used at intervals of 5 to 10 minutes. Children: No data are available on the use of Glyceryl TNT in children. Elderly: Hypotension and syncope can be a particular problem with use of nitrates in the elderly. Patients should be advised to sit down whenever possible when taking sublingual Glyceryl TNT. | 
