Source: Medicines & Healthcare Products Regulatory Agency (GB) Revision Year: 2018 Publisher: G. Pohl-Boskamp GmbH & CO KG., Kieler Strasse 11, 25551 Hohenlockstedt, Germany
Glyceryl trinitrate exerts a spasmolytic action on smooth muscle, particularly in the vascular system. The predominant effect is an increase in venous capacitance resulting in marked diminution of both the left ventricular filling pressure and volume (preload). There is also a reduction in afterload due to moderate dilation of the arteriolar resistance vessels. These haemodynamic changes lower the myocardial oxygen demand. By direct action and through the reduction of myocardial wall tension glyceryl trinitrate also lowers the resistance to flow in the coronary collateral channels and allows re-distribution of blood flow to ischaemic areas of the myocardium.
Administration of Nitronal by intravenous infusion to patients with congestive heart failure results in a marked improvement in haemodynamics, reduction of elevated left ventricular filling pressure and systolic wall tension, and an increase in the depressed cardiac output. It reduces the imbalance that exists between myocardial oxygen demand and delivery, thereby diminishing myocardial ischaemia and controlling ischaemia-induced ventricular arrhythmias.
It is important that the dose of Nitronal be titrated against the individual clinical response.
After intravenous administration, glyceryl trinitrate is widely distributed in the body with an estimated apparent volume of distribution of approximately 200 litres, and is rapidly metabolised to dinitrate and mononitrate with an estimated half life of 1 to 4 minutes, resulting in plasma levels of less than 1 microgram/ml.
None, of relevance to the prescriber, which are not given elsewhere in this document.
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