Nitroglycerin
Nitroglycerin (also known as glyceryl trinitrate (GTN)), a vasodilator best known for treatment of ischemic heart disease, has also been investigated for its potential therapeutic benefit in ischemic stroke.
Raises ICP (less than with nitroprusside due to preferential venous action) 1).
This agent produces a rapid, controllable, but not precipitous fall in blood pressure without rebound, is non-toxic, may not alter cerebrovascular autoregulation, and does not raise intracranial pressure 2).
Dosage
5 mcg/min
Increase by 5 mcg/min q3-5min up to 20 mcg/min, THEN
Increase by 10 mcg/min
May later increase by 20 mcg/min
Higher dosages required for PVC admin sets
Uninterrupted infusion >24 hours produces tolerance
1)
Cottrell JE, Patel K, Turndorf H, Ransohoff J. Intracranial pressure changes
induced by sodium nitroprusside in patients with intracranial mass lesions. J
Neurosurg. 1978 Mar;48(3):329-31. PubMed PMID: 632856.
2)
Chestnut JS, Albin MS, Gonzalez-Abola E, Newfield P, Maroon JC. Clinical
evaluation of intravenous nitroglycerin for neurosurgery. J Neurosurg. 1978
May;48(5):704-11. PubMed PMID: 417150.