Oral administration: Treatment or prevention of angina pectoris.
IV administration: Treatment of angina pectoris; acute decompensated heart failure; perioperative hypertension; induction of intraoperative hypotension.
Intra-anal administration (Rectiv ointment): Treatment of moderate to severe pain associated with chronic anal fissure.
Off Label Uses
Extravasation management, sympathomimetic vasopressors
Clinical experience suggests utility of topical nitroglycerin in the management of sympathomimetic vasopressor extravasations [Hurst 2004], [Reynolds 2014].
Hypertensive emergency
Based on the American College of Cardiology/American Heart Association guideline for the prevention, detection, evaluation, and management of high blood pressure in adults, nitroglycerin is an option for hypertensive emergency, especially if there is concomitant acute coronary syndrome or pulmonary edema [ACC/AHA [Whelton 2018]].
Uterine relaxation
Based on its ability to relax smooth muscle, nitroglycerin has been used in observational studies and case reports to induce uterine relaxation in obstetrical procedures such as removal of a retained placenta or when uterine inversion occurs following childbirth [Altabef 1992], [Axemo 1998], [Bayhi 1992], [Chedraui 2003], [Dayan 1996], [Dufour 1997], [Lowenwirt 1997].
Based on the American College of Obstetricians and Gynecologists guidelines for the treatment of postpartum hemorrhage, nitroglycerin is an option when uterine relaxation is needed in the management of uterine inversion [ACOG 183 2017]. Based on the American Society of Anesthesiologists practice guidelines for obstetric anesthesia, nitroglycerin may be used as an alternative agent for uterine relaxation during removal of retained placental tissue [ASA 2016].
