Nitroject Special Precautions

Nitroglycerin is readily absorbed into the plastic material or parenteral solution containers and tubings of intravenous infusion sets. Therefore, the dilution and storage of nitroglycerin for intravenous infusion should be made only in glass parenteral solution bottles.
Forty percent to eighty percent of the total amount of nitroglycerin in the final diluted solution for infusion is absorbed by the polyvinyl chloride (PVC) tubing of the intravenous administration sets. The rate of absorption depends upon the flow rate, nitroglycerin concentration and the length of the tubing, etc. Therefore, it is recommended that least absorptive tubings should be used for infusion of nitroglycerin injection.
In addition to the previously mentioned facts, dosing instructions must be carefully adhered to. It should be noted that the dosing recommendations are based upon the published studies in which PVC tubings have been used and these recommended doses may be too high if new, less absorptive infusion tubing is used.
Caution is advised in patients presenting with malnutrition, hypothyroidism, severe hypothermia, those who are predisposed to closed angle glaucoma or severe impairment of hepatic and/or renal function.
Excessive fall in blood pressure, especially for prolonged periods of time, must be avoided because of possible deleterious effects on the brain, heart, liver, kidney from poor perfusion and the attendant risks of ischaemia thrombosis and altered functions of these organs. Patients with normal or low pulmonary capillary wedge pressure are especially sensitive to the hypotensive effects of nitroglycerin injection. If pulmonary capillary wedge pressure is being monitored, it will be noted that a fall in wedge pressure precedes the onset of arterial hypotension and the pulmonary capillary wedge pressure is a useful guide to safe titration of the drug.
Nitroject injection contains propylene glycol which can lead to lactic acidosis. It is recommended that use of this preparation be restricted to not more than three successive days.
Evidence is not available to demonstrate the safety of nitroglycerin for intracoronary injection.
Use in Pregnancy & Lactation: The safety of the use of nitroglycerin injection during pregnancy has not been established, therefore, it should be given to pregnant women only if clearly needed.
It is not known whether nitroglycerin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when nitroglycerin injection is administered to a nursing woman.