# Nitroglycerin

Sublingual adult cardiac/pulmonary-edema treatment and separately authorized transport infusions.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/nitroglycerin/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- SO-C-015 says not to give if sildenafil, vardenafil, or tadalafil was taken within the preceding 24 hours.
- Recheck BP before repeat doses. I-15 and the condition orders use different boundary wording; this page identifies each condition order explicitly.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=4)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-C-015 — Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms](https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf)
- [SO-M-035 — Respiratory Distress](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-35%20Respiratory%2010-2025.pdf)
- [PR-225 — Monitoring Nitroglycerin Infusion during Interfacility Transports](https://www.ochealthinfo.com/sites/hca/files/import/data/files/49722.pdf)

## Use in OCEMS

- Use the chest-pain or respiratory-distress standing order that matches the presentation. Their blood-pressure boundaries differ.
- The available SL forms include 0.4 mg tablets, powder packets, and metered sprays.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Cardiac chest pain — SO-C-015 | 0.4 mg SL when systolic BP is above 100; repeat about every 3 minutes for discomfort, up to 3 EMS doses while BP stays above 100. Patient self-doses before EMS are not counted in those 3 doses. |
| Suspected CHF/pulmonary edema — SO-M-035 | 0.4 mg SL when systolic BP is at least 100; may repeat twice if it remains at least 100. At systolic BP at least 150, use 0.8 mg SL and may repeat twice while it stays at least 150; reduce to 0.4 mg if BP falls below 150 but remains above 100. |

## Pediatric

- No routine pediatric field nitroglycerin regimen is listed in I-20. Do not extrapolate the adult SL rows to children.
- Any pre-existing transport infusion requires the applicable transport authorization and sending-facility orders; it is not a pediatric field initiation dose.

## Pediatric dosing availability

- No routine pediatric field regimen is supplied by the cited OCEMS sources; do not scale an adult dose by weight.
| Weight | OCEMS pediatric dose |
| --- | --- |
| Any weight | No general pediatric dose under the cited source; follow the applicable order / medical direction. |

## Preparation & reassessment

- Check the formulation: one 0.4 mg dose is not the same as the 0.8 mg pulmonary-edema dose.
- PR-225 governs a pre-existing IFT nitroglycerin infusion; use the prescribed pump rate and its monitoring/stop criteria, not these SL doses.

## Interfacility infusion — PR-225

- Verify secure access, a working pump, the sending RN/physician’s prescribed rate, and any prior BP problem. Maintain that prescribed infusion rate.
- Monitor rhythm and vital signs continuously. If systolic BP falls below 90 or obvious poor perfusion develops, stop the infusion and transport to the nearest appropriate ERC.
- Document the rate, monitoring, patient condition, and any stop time/reason at handoff. This continuation pathway is distinct from the SL standing-order doses.