Clinical Conundrum:
How do you transition a patient from a nitroglycerin infusion to an alternative route of administration when there are no critical care beds?
Background:
As drug and bed shortages continue to be problematic for many hospitals around the Country, there are times alternative routes of administration for medications need to be considered.
While nitroglycerin paste (ointment) tends to offer less control and ability to titrate to specific effects, it is a useful alternative route of administration when Nitroglycerin infusion drug shortages exist and/or when transitioning patients to other services is difficult.
Answer:
Estimated Dose Conversions:
5 mcg/min IV infusion = 0.5" of paste
10 - 39 mcg/min IV infusion = 1.0" of paste
40 - 59 mcg/min IV infusion = 1.5" of paste
60 - 100 mcg/min IV infusion = 2.0" of paste
When switching a patient from IV infusion to ointment, apply the ointment and then 30 minutes later discontinue the IV infusion.
References:
Esposito GA, et al. Converting IV nitroglycerin therapy to nitroglycerin ointment therapy: a comparison of two methods. Am J Crit Care 1998;7(2):123-30.
Written by:
Joanne C. Routsolias, PharmD, RN, BCPS
Clinical PharmD Specialist - Emergency Medicine/Toxicology
Cook County Health