Niglina (Glyceryl Trinitrate)

Glyceryl trinitrate is used in the management of cardiovascular conditions that involve myocardial oxygen demand.

• Prophylaxis of angina pectoris: reduces the frequency of angina attacks in patients with stable coronary disease.
• Relief of acute angina attacks: provides rapid vasodilation to alleviate chest pain during an episode.
• Chronic heart failure (off‑label in some jurisdictions): may improve symptoms by decreasing cardiac preload.

• Glyceryl trinitrate acts as a nitric‑oxide donor. After absorption, it is converted to nitric oxide, which activates guanylate cyclase in vascular smooth‑muscle cells. The resulting increase in cyclic GMP leads to relaxation of smooth muscle, producing vasodilation of veins and arteries and lowering cardiac preload and afterload.

Adverse reactions are related to the vasodilatory properties of the nitrate and to local skin exposure.

Common Side Effects

• Headache: throbbing pain often occurring shortly after application.
• Flushing: warmth and redness of the face or upper torso.
• Dizziness or light‑headedness: due to transient blood pressure fall.
• Hypotension: mild to moderate reduction in systolic pressure.
• Skin irritation at the patch site: erythema, itching or mild rash.
• Tachycardia: compensatory increase in heart rate.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Syncope: fainting episodes caused by abrupt circulatory changes.
• Myocardial infarction: rare but possible if coronary perfusion is compromised.
• Allergic reaction: urticaria, angioedema or anaphylaxis.
• Severe skin necrosis: extensive tissue damage at the application site.

Before prescribing Niglina, clinicians should evaluate cardiovascular status and consider patient‑specific factors.

• Assess blood pressure and heart rate: ensure values are stable before initiating therapy.
• Review concomitant nitrate use: avoid additive vasodilatory effects.
• Evaluate for phosphodiesterase‑5 inhibitor therapy: contraindicated due to risk of profound hypotension.
• Monitor for tolerance development: efficacy may diminish with continuous use.
• Educate patients on proper patch rotation: change site daily to reduce skin irritation.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Glyceryl trinitrate may interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Phosphodiesterase‑5 inhibitors (e.g., sildenafil, tadalafil, vardenafil): can cause severe hypotension.
• Other nitrates or nitroglycerin preparations: additive vasodilation may lead to dangerous blood pressure drops.
• Antihypertensive agents in high doses: may amplify blood pressure‑lowering effects.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may mask tachycardia, complicating assessment of hypotensive episodes.
• Diuretics: can enhance the hypotensive response.
• Alcohol: may increase vasodilatory effects and dizziness.