Nitroglycerin Side Effects and Management

Cardiovascular Effects

The American College of Cardiology notes that hypotension, particularly orthostatic/postural, and reflex tachycardia are potential cardiovascular effects of nitroglycerin 1, 2, 3
The European Heart Journal reports that flushing is also a possible cardiovascular effect of nitroglycerin 2
Fainting, especially when standing up quickly, is a potential effect of nitroglycerin, as noted by the American College of Cardiology 4

The American College of Cardiology warns that severe hypotension is a serious potential complication of nitroglycerin, which may result in reflex tachycardia and worsening myocardial ischemia 1, 4
The American College of Cardiology also notes that nitroglycerin may worsen hypoxemia by increasing ventilation-perfusion mismatch 1, 4
Nitrate tolerance, or attenuation or loss of the anti-ischemic effect during continuous nitrate medication, is a potential serious side effect of nitroglycerin, as reported by the European Heart Journal 2

The American College of Cardiology recommends that nitroglycerin be used with extreme caution or avoided in patients with right ventricular infarction, as they are especially dependent on adequate right ventricular preload to maintain cardiac output 1, 4
The American College of Cardiology also advises careful titration of nitroglycerin in patients with inferior wall myocardial infarction due to frequent association with right ventricular infarction 1
The American College of Cardiology notes that nitroglycerin is contraindicated in patients who have recently taken medications for erectile dysfunction, such as within 24 hours of sildenafil or vardenafil, or within 48 hours of tadalafil 5
The European Heart Journal reports that severe anemia, increased intracranial pressure, and other conditions are contraindications for nitroglycerin 2

The European Heart Journal recommends discontinuing the drug, elevating legs, and administering rapid fluid to manage hypotension 1, 2
The American College of Cardiology suggests considering atropine for associated bradycardia 4
The European Heart Journal advises providing a "nitrate-free interval" each day (typically 10-12 hours) to prevent tolerance 6, 2

The European Heart Journal recommends regular monitoring of blood pressure, especially when initiating therapy or adjusting doses 2, 5
The American College of Cardiology notes that monitoring heart rate for significant changes, particularly tachycardia or bradycardia, is essential 4
The European Heart Journal suggests using the smallest effective dose to minimize side effects while maintaining therapeutic benefit 2