Indication
Acute pulmonary oedema, unstable angina, hypertensive emergency (with LV failure).
Preparation
50 mg in 250 mL D5W or NS via polyethylene set (avoid PVC — adsorbs GTN).
Dilution
200 mcg/mL
Rate
Start 5–10 mcg/min IV; titrate by 5–10 mcg/min q3–5 min to symptom relief (max 200 mcg/min).
Monitoring
- • Continuous BP (arterial line preferred at high doses)
- • HR, symptoms of chest pain
- • SpO2
Common errors
- • PVC tubing → 40–80% drug loss
- • Hypotension with RV MI or hypovolaemia
- • Concomitant PDE5 inhibitor (24–48 h) → catastrophic hypotension
Pearls
- • Tolerance in 24–48 h — plan for early transition
- • Preload > afterload reduction at low doses
