• Acute pulmonary oedema
• Uncontrolled pain of cardiac origin, including aortic dissection
• Accelerated hypertension with pulmonary oedema or acute coronary syndrome

• GTN 1 mg/mL in 50 mL ampoule

• Compatible syringes and tubing
• rigid plastic syringes (e.g. Gillette Sabre, Brunswick Disposable, BD Plastipak)
• polyethylene tubing (e.g. Vygon Lectrocath, David Bull Laboratories Types A261 or A2001)
• GTN is incompatible with
• polyvinylchloride (PVC) infusion bags (e.g. Steriflex, Boots, Viaflex, Travenol)

Acute pulmonary oedema

• GTN by continuous IV infusion, initially 20 microgram/min
• decreasing to 10 microgram/min; or
• increasing in increments of 20 microgram/min at 15-30 min intervals
• until desired response or a maximum of 200 microgram/min is achieved
• Provided BP remains >90 mmHg systolic and >60 mmHg diastolic

Uncontrolled pain of cardiac origin

• GTN by continuous IV infusion, initially 10 microgram/min
• titrated upwards at 15 min intervals in increments of 5 or 10 microgram/min
• until desired response in pain control to a maximum of 200 microgram/min
• Provided BP remains >90 mmHg systolic and >60 mmHg diastolic

Accelerated hypertension

• If patient also has Acute pulmonary oedema or Uncontrolled pain of cardiac origin, follow appropriate dosage instructions as above
• Otherwise give GTN by continuous IV infusion, initially 5 microgram/min
• titrated upwards at 15 min intervals in increments of 5 or 10 microgram/min
• according to patient response to a maximum of 100 microgram/min
• See Accelerated (malignant) hypertension guideline

• Fill a compatible 50 mL syringe with GTN solution 1 mg/mL (50 mL)
• Administer via a syringe pump, and titrate pump rate according to patient response

50mL syringe of 1 mg/mL solution

Remember

• In acute pulmonary oedema, maximum rate is 200 microgram/min
• In uncontrolled pain of cardiac origin, maximum rate is 200 microgram/min
• In accelerated hypertension, maximum rate is 100 microgram/min