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nitroglycerin

Pronunciation

Generic Name: nitroglycerin (oral/sublingual) (NYE troe GLI ser in (OR al/sub LIN gwal))
Brand Name: Nitro-Time, Nitrolingual, Nitrolingual Duo Pack, Nitromist, Nitrostat

What is nitroglycerin?

Nitroglycerin is in a group of drugs called nitrates. Nitroglycerin dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump.

Nitroglycerin is used to treat or prevent attacks of chest pain (angina).

Nitroglycerin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about nitroglycerin?

Do not use nitroglycerin if you are taking sildenafil (Viagra, Revatio), tadalafil (Cialis), or vardenafil (Levitra). Serious, life-threatening side effects can occur if you take nitroglycerin while you are using sildenafil.

Nitroglycerin can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use nitroglycerin. Do not stop taking the medication. Ask your doctor before using any headache pain medication.

What should I discuss with my healthcare provider before taking nitroglycerin?

Do not use nitroglycerin if you are taking sildenafil (Viagra, Revatio), tadalafil (Cialis), or vardenafil (Levitra). Serious, life-threatening side effects can occur if you take nitroglycerin while you are using sildenafil.

Do not use this medication without the advice of a doctor if you have early signs of a heart attack (chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling). Seek emergency medical attention if you have symptoms of a heart attack.

You should not use this medication if you are allergic to nitroglycerin or other nitrates such as isosorbide dinitrate (Dilatrate, Isordil, Isochron) or isosorbide mononitrate (Imdur, ISMO, Monoket), or if you have:

  • severe anemia (a lack of red blood cells); or

  • a brain injury, hemorrhage, or tumor.

To make sure you can safely take nitroglycerin, tell your doctor if you have any of these other conditions:

  • congestive heart failure;

  • a history of heart attack, stroke, or head injury;

  • low blood pressure;

  • glaucoma;

  • migraine headaches; or

  • liver disease.

FDA pregnancy category C. It is not known whether nitroglycerin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether nitroglycerin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Nitroglycerin can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use nitroglycerin. Do not stop taking the medication. Ask your doctor before using any headache pain medication.

How should I take nitroglycerin?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

If possible, try to rest or stay seated when you use this medication. Nitroglycerin can cause dizziness or fainting.

If you use nitroglycerin sublingual spray to treat an angina attack: At the first sign of an attack, apply the spray directly on or under your tongue. Close your mouth after each spray. Do not inhale the spray. Do not shake the spray before or during use. You may use additional sprays every 5 minutes, but not more than 3 sprays in 15 minutes.

You may use nitroglycerin spray within 5 to 10 minutes before an activity you think might cause chest pain. Follow your doctor's instructions.

The nitroglycerin sublingual tablet should be placed under your tongue and allowed to dissolve slowly. Do not chew or swallow it. You may use additional tablets every 5 minutes, but not more than 3 tablets in 15 minutes.

Seek emergency medical attention if your chest pain gets worse or lasts more than 5 minutes, especially if you have trouble breathing or feel weak, dizzy, or nauseated, or lightheaded.

You may feel a slight burning or stinging in your mouth when you use this medication. However, this sensation is not a sign of how well the medication is working. Do not use more medication just because you do not feel a burning or stinging.

Do not crush, chew, break, or open an extended-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using nitroglycerin.

Keep this medicine on hand at all times in case of an angina attack. Get your prescription refilled before you run out of medicine completely.

If you take nitroglycerin on a regular schedule to prevent angina, do not stop taking it suddenly or you could have a severe attack of angina.

Store the tablets in the glass container at room temperature, away from moisture and heat. Keep the spray away from open flame or high heat, such as in a car on a hot day. The canister may explode if it gets too hot.

What happens if I miss a dose?

Since nitroglycerin is taken as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 2 hours away. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of nitroglycerin can be fatal.

Overdose symptoms may include a severe throbbing headache, confusion, fever, fast or pounding heartbeats, dizziness, vision problems, nausea, vomiting, bloody diarrhea, trouble breathing, cold or clammy skin, feeling light-headed, fainting, and seizures.

What should I avoid while taking nitroglycerin?

Nitroglycerin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol. It can increase some of the side effects of nitroglycerin, such as dizziness, drowsiness, feeling light-headed, or fainting.

Nitroglycerin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • fast, slow, pounding, or uneven heart rate;

  • blurred vision or dry mouth;

  • nausea, vomiting, sweating, pale skin, feeling like you might pass out; or

  • fever, sore throat, and headache with a severe blistering, peeling, and red skin rash.

Less serious side effects may include:

  • mild burning or tingling with the tablet in your mouth;

  • warmth, redness, or tingly feeling under your skin; or

  • feeling weak or dizzy.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Nitroglycerin dosing information

Usual Adult Dose for Angina Pectoris:

For relief of acute anginal attack:

Lingual spray: 1 to 2 sprays (0.4 to 0.8 mg) onto or under the tongue every 3 to 5 minutes as needed, up to 3 sprays in 15 minutes. If pain persists after the maximum number of doses, prompt medical attention is recommended.

Sublingual tablet: 0.3 to 0.6 mg dissolved under the tongue or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes. If pain persists after the maximum number of doses, prompt medical attention is recommended.

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed, up to a usual maximum of 200 and generally no more than 400 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Angina Pectoris Prophylaxis:

Lingual spray: 1 to 2 sprays (0.4 to 0.8 mg) onto or under the tongue 5 to 10 minutes prior to engaging in activities which might precipitate an acute attack

Sublingual tablet: 0.3 to 0.6 mg dissolved under the tongue or in the buccal pouch 5 to 10 minutes prior to engaging in activities which might precipitate an acute attack

Topical ointment: 1/2 inch initially, applied to a non hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. If angina occurs while the ointment is in place, the dose should be increased; if angina occurs several hours after application, the dosing frequency should be increased. Usual range is 1/2 to 2 inches (7.5 to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.

Transdermal patch: 0.1 to 0.4 mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr. Application sites should be rotated to avoid skin irritation.

Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. If angina occurs while a tablet is in place, the dose should be increased to the next strength; if angina occurs after dissolution of tablet, the dosing frequency should be increased. Usual maintenance dosage is 2 mg three times a day. If an acute attack occurs while a tablet is in place, another tablet may be administered on the opposite side from the one already in place. Sublingual nitroglycerin is recommended if prompt relief is not attained.

Oral: 2.5 every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours

Because tolerance to nitroglycerin may develop if plasma levels are maintained continuously, a nitrate free interval of 10 to 12 hours per day may be appropriate during chronic prophylaxis of angina pectoris. However, clinical studies suggest that such intermittent use may be associated with hemodynamic rebound during drug withdrawal and decreased exercise tolerance during the latter part of the nitrate free interval. Although the clinical relevance of this observation is unknown, a potentially increased risk of anginal attack during the nitrate free interval should be considered. Therefore, dosing regimens should be carefully individualized to each patient. Other antianginal drugs such as beta-blockers and calcium channel blockers may be prescribed to reduce the risk of aggravating myocardial ischemia during the drug free intervals.

Usual Adult Dose for Congestive Heart Failure:

Topical ointment: 1/2 inch initially, applied to a non hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. Usual range is 1/2 to 2 inches (7.5 to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.

Transdermal patch: 0.1 to 0.4 mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr. Application sites should be rotated to avoid skin irritation.

Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. Usual maintenance dosage is 2 mg three times a day.

Oral: 2.5 every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours

Usual Adult Dose for Myocardial Infarction:

For the initial 24 to 48 hours after an acute myocardial infarction:

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed up to a usual maximum of 200 and generally no more than 400 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Hypertension:

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed up to a usual maximum of 100 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Anal Fissure and Fistula:

For the treatment of moderate to severe pain associated with chronic anal fissure:
Apply 1 inch of ointment (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) intra anally every 12 hours for up to 3 weeks.

Usual Pediatric Dose for Hypertension:

Perioperative hypertension or induction of intraoperative hypotension:

IV continuous infusion: 0.25 to 0.5 mcg/kg/min initially, increase by 0.5 to 1 mcg/kg/min every 3 to 5 minutes as needed up to 5 mcg/kg/min. Usual dose is 1 to 3 mcg/kg/min, but doses as high as 20 mcg/kg/min have been used.

What other drugs will affect nitroglycerin?

Many drugs can interact with nitroglycerin. Below is just a partial list. Tell your doctor if you are using:

  • alteplase (Activase);

  • aspirin or heparin;

  • bladder or urinary medications such as oxybutynin (Ditropan) or tolterodine (Detrol);

  • blood pressure medication;

  • bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);

  • dihydroergotamine (D.H.E. 45, Migranal) or ergotamine (Ergomar, Cafergot, and others);

  • an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), clomipramine (Anafranil), imipramine (Tofranil), and others;

  • a beta-blocker such as atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), and others;

  • a calcium channel blocker such as diltiazem (Tiazac, Cardizem), nifedipine (Procardia), nimodipine (Nimotop), verapamil (Calan, Covera, Verelan), and others;

  • irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, and others), or propantheline (Pro-Banthine);

  • any medication that causes dry mouth; or

  • medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), thioridazine (Mellaril), and others.

This list is not complete and there are many other drugs that can interact with nitroglycerin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about nitroglycerin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 12.01. Revision Date: 2011-08-12, 2:55:37 PM.

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