Contraindications for Nitroglycerin Administration

Absolute Contraindications

The American Heart Association recommends avoiding nitroglycerin administration in patients with hypotension, defined as systolic blood pressure <90 mmHg or ≥30 mmHg below baseline, due to the risk of worsening hypotension 1, 3
The American College of Cardiology advises against administering nitroglycerin within 12 hours of avanafil, 24 hours of sildenafil/vardenafil, or 48 hours of tadalafil due to the risk of profound hypotension 4
Nitroglycerin is contraindicated in patients with right ventricular infarction, as it can cause dangerous preload reduction 1, 5
The American Heart Association recommends avoiding nitroglycerin in patients with extreme bradycardia, defined as heart rate <50 bpm, due to the risk of worsening bradycardia 1, 3
The American College of Cardiology advises against administering nitroglycerin to patients with tachycardia >100 bpm unless heart failure is present, due to the risk of worsening tachycardia 1, 3

The American Heart Association recommends considering benzodiazepines as first-line therapy for cocaine-associated chest pain, but notes that nitroglycerin can be used to relieve symptoms 6