Q: What are the dosing guidelines for the titration of intravenous (IV) nitroglycerine in ST elevation myocardial infarction (STMI)?


Answer: According to American College of Cardiology/American Heart Association (ACC/AHA) guidelines on ST elevation myocardial infarction (STEMI), "IV Nitro" can be started at very low dose from 5-10 µg/min and titrated slowly up with caution  by 5-20 µg/min every 10 minutes till either chest pain (and related symptoms) resolved or a mean arterial blood pressure (MAP) 10 percent below baseline in normotensive patients and up to 25-30 percent in hypertensive patients is achieved. Ideally, systolic pressure should not fall below 90 mmHg or by more than 30 mmHg.

Maximum effective dose is around 400 µg/min. 



Reference: 

O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:e362.