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Infusion GTN dose in adults for hypertension

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nitroglycerin intravenous infusion dose hypertensive emergency adults prescribing information

IV GTN (nitroglycerin) infusion in adults for severe hypertension / hypertensive emergency:
  • Start: 5 micrograms/minute via an infusion pump using non-adsorbing tubing.
  • Titrate: increase by 5 micrograms/minute every 3-5 minutes until response. Once at about 20 micrograms/minute, larger increments such as 10 micrograms/minute may be used according to local protocol.
  • Usual effective range: roughly 5-100 micrograms/minute.
  • Maximum: 400 micrograms/minute in the product information, although such doses require critical-care level monitoring and are uncommon.
If using conventional PVC tubing, GTN is adsorbed to the tubing, so product labeling may begin at 20 micrograms/minute instead. Use the concentration and line-specific infusion chart supplied locally. DailyMed prescribing information specifies 5 micrograms/minute with non-absorbing sets.
Clinical points
  • Best suited when hypertension accompanies acute pulmonary edema, acute coronary syndrome/ischemia, or perioperative hypertension. It is not usually the preferred sole agent for uncomplicated severe hypertension.
  • Use continuous BP monitoring, ideally an arterial line for a true hypertensive emergency.
  • Avoid with PDE-5 inhibitors such as sildenafil, tadalafil, or vardenafil, and use extreme caution in hypotension, right-ventricular infarction, severe aortic stenosis, or raised intracranial pressure.
  • BP reduction should be controlled, commonly no more than about 20-25% of MAP in the first hour unless a condition-specific target applies.
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