Nitroglycerin is chemically an ester of a polyhydric alcohol (ie glycerin) and nitric acid. When used as a medicine, it is supposed to dilate blood vessels, arteries and veins, therefore it is used to treat diseases of the venous system.

Nitroglycerinwas originally known as an explosive material with a distinctive, thick and oily consistency. It was received in 1847 by an Italian professor of chemistry, Ascanio Sobrero, as a result of nitration of glycerin with a mixture of nitric and sulfuric acids.

Despite the fact that Sobrero knew perfectly well the explosive properties of the discovered substance, called pyroglycerine, he could not find any practical applications for it, although it was much stronger than gunpowder. The main problem was its great sensitivity to even small mechanical stimuli. It was enough that the mixture was overheated locally and an explosion also took place - usually uncontrolled. For this reason, accidents quite often happened during its production.

A solution to the problem of nitroglycerin sensitivity was found only in 1866 by the Swedish chemist Alfred Nobel and he is mainly associated with this substance. Nobel's breakthrough discovery was the impregnation of silica with nitroglycerine - this is how the dynamite known and used to this day was created. This invention was patented in 1867 and quickly became available all over the world.

Nitroglycerin started to be used in medicine later - in 1879 William Murrell (an English physician) discovered the anti-anginal effect of an orally administered nitroglycerin solution. It then became the most popular medication prescribed by doctors for heart problems.

In the 20th century, large-scale research on the use of nitroglycerin derivatives in medicine was carried out and the production of new, safer and with a greater spectrum of action medical preparations for the treatment of coronary heart disease began.

Despite the significant increase in the number of drugs used in the treatment of these diseases, nitroglycerin has been very popular so far, because many doctors say that it and its derivatives are one of the best groups of drugs used in the treatment of ischemic heart disease. Therefore, it is still used in emergency medical services, in outpatient treatment, as well as inhospitals.

Contents:

  1. Nitroglycerin - action
  2. In what form can nitroglycerin be used?
  3. Who is the most commonly used nitroglycerin?
  4. Nitroglycerin - contraindications
  5. Nitroglycerin - interactions with other drugs
  6. Nitroglycerin and alcohol
  7. Nitroglycerin - effect on driving ability

Nitroglycerin - action

Nitroglycerin reduces the heart's need for oxygen by reducing the so-called preload and afterload.

Preload is the force with which the wall of the heart's ventricle is stretched by the blood at the end of its diastole, and afterload is the resistance that the ventricle overcomes when blood is ejected. The greater these loads, the harder the heart works and uses more oxygen. Nitroglycerin releases nitric oxide, which dilates blood vessels, thus relieving the heart and lowers blood pressure.

However, it should be remembered that at the beginning of nitroglycerin treatment, some disturbing symptoms may occur, e.g. headaches caused by vasodilation, usually subsiding after a few days - as soon as the body gets used to the drug. They may also appear:

  • skin redness
  • dizziness
  • nausea and vomiting
  • sudden drop in blood pressure
  • weakness
  • fainting
  • anxiety
  • excessive sweating
  • allergic reactions

Aerosol administration can sometimes cause a burning sensation in the mouth.

The symptoms of angina may worsen occasionally. This is the so-called paradoxical reaction of the body to nitrates - it concerns a very small group of patients.

All symptoms should disappear after a few, sometimes a dozen or so days of using the drug, but if they persist for a long time, consult a doctor. You may need to reduce the dose - however, never do it "on your own".

In what form can nitroglycerin be used?

The following forms of nitroglycerin are available on the pharmaceutical market:

  • sublingual tablets
  • aerosol (administered orally) [treatment of acute attacks of angina]
  • ointment [prevents angina pains]
  • patches
  • solution for intravenous infusion

Nitroglycerin in the form of a solution for intravenous infusionis used in:

  • unstable angina
  • myocardial infarction
  • pulmonary edema in the course of acute left ventricular failure
  • breakthroughhypertensive with circulatory failure
  • controlled lowering of blood pressure during surgery

After intravenous administration, the effect of the drug begins 1-2 minutes after the start of the infusion. However, the final effect of the action depends on the individual reaction of the body, but also on other comorbidities and preparations taken at the same time.

Who is the most commonly used nitroglycerin?

  • in patients with ischemic heart disease - the drug is most often administered in the form of sublingual tablets or an aerosol. In this case, nitroglycerin is administered to stop coronary pain, as well as preventively before planned physical exertion, a stressful situation or the expected exposure to low temperature. However, it should only be used temporarily and not as a permanent treatment.
  • in severely hypertensive patients
  • in some patients with pulmonary edema
  • in patients during a heart attack - the administration of nitroglycerin during this time reduces the area of ​​the heart that is ischemic

Nitroglycerin - contraindications

The main contraindications include:

  • hypersensitivity to organic nitrates (anaphylactic reaction may even occur)
  • cardiogenic shock
  • intracranial bleeding
  • acute heart failure
  • severe anemia
  • very low blood pressure

Nitroglycerin - interactions with other drugs

Preparations containing nitroglycerin may interact with drugs such as:

  • antihypertensive drugs, i.e. drugs lowering blood pressure - the use of nitroglycerin in parallel with antihypertensive drugs and other drugs that can lower blood pressure may dangerously intensify their effects, and this may even lead to serious fainting
  • calcium antagonists
  • diuretics
  • beta blockers
  • acetylsalicylic acid - it may increase the concentration of nitroglycerin in the blood, probably it is the result of a decrease in clearance, i.e. the ability to remove a given substance from the body, in this case nitroglycerin
  • heparin - nitrates can reduce the anticoagulant effect of heparin. Be careful and be sure to monitor your anticoagulant treatment when taking these two drugs at the same time

Therefore, before starting nitroglycerin treatment, inform your doctor about all medications you are taking - including over-the-counter medications, including herbal remedies.

Nitroglycerin and alcohol

You must not drink alcohol while using the preparation. Consuming alcohol and nitroglycerin at the same time increases the risk of severe hypotension and fainting.

Nitroglycerin - effect on driving ability

At the beginning of the treatment, driving, operating any machinery and performing other activities with an increased risk of accidents is inadvisable or even prohibited. All because the preparation may cause dizziness, fainting and other symptoms that may impair psychophysical fitness and the ability to drive vehicles, and this poses a threat to the life and he alth of the patient and those around him.

Warning!

Nitroglycerin should not be taken together with drugs used to treat erectile dysfunction, such as the very popular and over-the-counter sildenafil. Because, like nitroglycerin, they dilate blood vessels. Taking both drugs can lead to a very significant reduction in blood pressure, which in extreme cases can be life-threatening. Therefore, before taking e.g. sildenafil, consult your doctor.

About the authorKarolina NowakA pharmaceutical technician by education. Currently, he is professionally fulfilled working in a pharmacy. Empathetic, sensitive and fond of contact with other people. Privately, a lover of a good book.

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