While nitroglycerin paste (or ointment; i.e., "nitropaste") offers less control and ability to titrate to specific effects, it can be a useful route of administration when drug shortages exists with other dosage forms and/or when transitioning patients to other services. 

• If switching a patient from IV infusion to ointment, apply the ointment and then 30 minutes later stop the IV infusion. 
  
• If going from the ointment to an IV infusion the duration of nitroglycerin ointment can stick around a lot longer (up to ~12 hrs) and be less predictable, so approximately one hour after the ointment has been removed, start the IV infusion at the equivalent lower end of the range and adjust as needed.  

Estimated Dose Conversions:

• 0.5" of paste = 5 mcg/min IV infusion
• 1.0" of paste = 10 - 39 mcg/min IV infusion
• 1.5" of paste = 40 - 59 mcg/min IV infusion
• 2.0" of paste = 60 - 100 mcg/min IV infusion

Editor-in-Chief:  Anthony J. Busti, MD, PharmD, FNLA, FAHA
Peer-Reviewer:  Dylan Kellogg, MD
Last Reviewed:  Augus 2015