硝酸甘油
Nitroglycerin
Glyceryl trinitrate
別名: Nitro-bid · Minitran · Nitro-Dur · Nitrek · glyceryl trinitrate · glonoine · GTN · nitroglycerol · NTG · trinitrin · trinitroglycerin
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Adjunctive treatment of heart failure | 2% NTG at ¼ to 1 inch | Topical | q6-12h | — | 🌎 NA |
| Adjunctive treatment of heart failure | 2.5-10 mg/24hr transdermal patch | Topical | 12 hours on, 12 hours off | — | 🌎 NA |
| Adjunctive treatment of pulmonary edema | ¼-2 inches | Topical/Mucous membranes | q8h | during the first 48 hours | 🌎 NA |
| Cardiogenic pulmonary edema (headed for oxygen) | ¼ inch for small dogs up to 1 inch for large dogs | Topical | q8h | for the first 24 hours | 🌎 NA |
| Venodilator for adjunctive treatment of systolic heart failure | ¼ inch per 5 kg of body weight of the 2% ointment | Topical | three times daily | for the first 24 hours | 🌎 NA |
- Adjunctive treatment of heart failure: If nitroprusside not used; apply to hairless area in the axilla or groin.
- Adjunctive treatment of pulmonary edema: Applied cutaneously or directly to mucous membranes (all animals tolerate the paste given orally).
- Cardiogenic pulmonary edema (headed for oxygen): Apply on the inner ear pinnae, groin or axilla as needed. Wear gloves to apply.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Adjunctive treatment of heart failure (severe pulmonary edema secondary to HCM) | ⅛th to ¼ inch of a 2% cream | Topical | every 4-6 hours | for the first 24 hours | 🌎 NA |
| To enhance resolution of pulmonary edema | ¼ to ½ inch | Topical | q6h | — | 🌎 NA |
| Adjunctive treatment of heart failure | 2.5-5 mg/24hr transdermal patch | Topical | 12 hours on, 12 hours off | — | 🌎 NA |
| Adjunctive treatment of pulmonary edema | ¼ inch | Topical/Mucous membranes | every 8 hours | during the first 48 hours | 🌎 NA |
| Cardiogenic pulmonary edema (headed for oxygen) | ¼ inch | Topical | q8h | for the first 24 hours | 🌎 NA |
| Adjunctive treatment of hypertension | ¼ inch | Topical | q6-8h | — | 🌎 NA |
- Adjunctive treatment of heart failure (severe pulmonary edema secondary to HCM): Apply to a hairless area (e.g., inside the earflap) as long as furosemide is being administered concomitantly. Efficacy is suspect but safe. Wear gloves.
- To enhance resolution of pulmonary edema: To reduce nitrate tolerance, alternate 12 hrs with and 12 hrs without nitroglycerin therapy.
- Adjunctive treatment of pulmonary edema: Applied cutaneously or directly to mucous membranes.
- Cardiogenic pulmonary edema (headed for oxygen): Apply on the inner ear pinnae, groin or axilla as needed. Wear gloves to apply.
- Adjunctive treatment of hypertension: Applied to pinna.
雪貂
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Adjunctive therapy for heart failure | ⅛th inch strip | Topical | q12h | for the first 24 hours of therapy | 🌎 NA |
| Dilative cardiomyopathy | ⅛th of an inch | Topical | once to twice daily | — | 🌎 NA |
- Adjunctive therapy for heart failure: Applied to inside of pinna.
- Dilative cardiomyopathy: Applied to shaved skin. Apply to ear pinna or skin of thigh. May cause hypotension.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
硝酸甘油 (NTG) 是一種強效、速效的有機硝酸鹽，在獸醫學中主要作為靜脈擴張劑使用。
- 主要用途：作為充血性心衰竭 (CHF) 和心因性肺水腫的急性輔助治療。
- 臨床要點：由於連續使用 48-72 小時內會迅速產生硝酸鹽耐受性 (tachyphylaxis)，因此通常僅限於急診住院期間的短期穩定治療，而不作為慢性的門診藥物。常採用間歇性給藥（例如：使用 12 小時，停用 12 小時）來減輕耐受性。
- 給藥方式：最常以局部塗抹（藥膏或透皮貼片）的方式，應用於無毛區域，如耳廓內側、腋下或腹股溝。
注意：雖然在人類心絞痛和急性高血壓中非常有效，但由於小動物的透皮吸收差異大且容易產生耐受性，其療效有時存在爭議，但它仍是急重症照護中處理急性體液過載的重要藥物。
作用機制
Nitroglycerin acts as a prodrug that donates nitric oxide (NO) to vascular smooth muscle, initiating a cascade that leads to vasodilation.
- Nitroglycerin → converted to Nitric Oxide (NO) in smooth muscle cells.
- NO → activates the enzyme soluble guanylyl cyclase (sGC).
- sGC → increases intracellular levels of cyclic GMP (cGMP).
- cGMP → activates protein kinase G (PKG) → leads to dephosphorylation of myosin light chains.
- Result: Vascular smooth muscle relaxation.
Pharmacological Pearl: At standard doses, NTG primarily dilates venous capacitance vessels. This significantly reduces preload (left ventricular end-diastolic pressure) and venous return to the heart, effectively relieving pulmonary congestion and decreasing myocardial oxygen demand. At higher doses, it may also provide some arteriolar dilation, thereby reducing afterload.
安全性與警告
禁忌症
- Severe anemia
- Hypersensitivity to nitrates
不良反應
- Rashes or erythema at the application site
- Orthostatic hypotension
- Transient headaches (common in humans, suspected in animals)
- Lethargy or weakness secondary to hypotension
注意事項
Important Warnings
- Hypotension Risk: Use with extreme caution (if at all) in patients with diuretic-induced hypovolemia, cerebral hemorrhage, head trauma, or other hypotensive conditions.
- Tolerance: Continuous use (48-72 hours) results in the rapid development of tolerance to the drug's effects. Intermittent dosing is recommended.
- Human Exposure: Personnel applying the drug must wear non-permeable gloves to prevent self-absorption, which can cause severe headaches and hypotension.
- Pregnancy: FDA Category C. Use cautiously as a last resort when the benefit clearly outweighs the risks. Unknown if excreted in maternal milk; use with caution in nursing animals.
藥物相互作用
Use of nitroglycerin with other antihypertensive drugs may cause additive hypotensive effects.
May increase hypotensive effects.
May profoundly increase risk for severe, potentially fatal hypotension.
監測
- Clinical efficacy (resolution of pulmonary edema, improved breathing)
- Sites of application for signs of rash or erythema
- Blood pressure, particularly if hypotensive effects (lethargy, weakness) are seen
藥物動力學
吸收
Absorbed through the skin. Onset of action usually within 1 hour; duration of action is 2-12 hours. Transdermal patches have wide inter-patient bioavailability.
分佈
Systemic distribution following transdermal absorption.
代謝
Metabolized in the liver. At least two metabolites have some vasodilator activity and have longer half-lives than the parent drug.
排除
Not explicitly detailed in the monograph.
過量
If severe hypotension results after topical administration:
- Decontamination: Immediately wash the site of application with soap and water to prevent any further absorption of the ointment.
- Supportive Care: Intravenous fluids may be administered if necessary to support blood pressure.
- Contraindications: Epinephrine is contraindicated as it is ineffective in this scenario and may further complicate the animal's cardiovascular condition.
可用產品
劑型
- Topical ointment (2%)
- Transdermal patches (0.1 mg/hr to 0.8 mg/hr)
- Sublingual tablets (human)
- Buccal tablets (human)
- Lingual spray (human)
- Extended-release oral capsules/tablets (human)
- Parenteral solutions for IV infusion (human)
人用標示
- Nitroglycerin Topical Ointment: 2% in a lanolin-white petrolatum base in 30 g & 60 g tubes and UD 1 g (Nitro-bid®, generic)
- Nitroglycerin Transdermal Systems (patches): 0.1 mg/hr, 0.2 mg/hr, 0.3 mg/hr, 0.4 mg/hr, 0.6 mg/hr & 0.8 mg/hr (Minitran®, Nitro-Dur®, Nitrek®, generic)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
The topical ointment should be stored at room temperature with the cap firmly attached.
飼主須知
重要的安全與塗抹指南
- 安全第一（戴手套）：塗抹藥膏或處理貼片時，請務必戴上不透水手套（如乳膠或丁腈手套）。硝酸甘油很容易透過人類皮膚吸收，可能會導致嚴重的頭痛、頭暈或使您自身的血壓危險下降。
- 測量劑量：藥膏的劑量是以「英吋」為單位測量的。請使用產品附帶的專用測量紙，準確擠出獸醫師處方的劑量。
- 塗抹方式：按照指示將藥膏塗抹在無毛區域（通常是耳垂內側、腹股溝或腋下）。將藥膏均勻揉入皮膚中。
- 輪換塗抹部位：每次給藥時請更換塗抹部位（例如：從左耳換到右耳）。這可以防止皮膚刺激並幫助藥物更好地吸收。如果出現皮疹，在完全消退前請勿再次使用該部位。
- 避免接觸：請勿撫摸寵物塗抹藥膏的部位。讓接受治療的寵物遠離可能觸摸或舔舐該部位的兒童或其他動物。
- 何時聯繫獸醫師：如果皮疹持續存在，或者您的寵物顯得異常虛弱、步態不穩或嗜睡（這可能是低血壓的跡象），請聯繫您的獸醫師。
- 消防安全：儘管它的名字和歷史上作為炸藥的背景聽起來很嚇人，但醫療用的硝酸甘油已被大量稀釋，使用本產品沒有爆炸或起火的危險。
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