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nitroglycerin

Pronunciation

Generic Name: nitroglycerin (topical) (NYE troe GLIS er in)
Brand Name: Nitro-Bid, Nitrol Appli-Kit

What is nitroglycerin topical?

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 topical (for the skin) is used to prevent attacks of chest pain (angina).

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

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

You should not use this medication if you are allergic to nitroglycerin, isosorbide mononitrate (Imdur), or isosorbide dinitrate (BiDil, Isordil).

Before using nitroglycerin topical, tell your doctor if you have congestive heart failure, low blood pressure, glaucoma, anemia, or a history of heart attack, stroke, or head injury.

Do not use this medication to treat an angina attack that has already begun. It will not work fast enough.

Nitroglycerin topical can cause severe headaches, especially when you first start using it. Do not stop using nitroglycerin, and ask your doctor before using any headache pain medication.

Nitroglycerin topical 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 topical.

Call your doctor at once if you have a serious side effect such as worsening chest pain, pain spreading to the arm or shoulder, nausea, vomiting, sweating, blurred vision and dry mouth, or fainting.

What should I discuss with my healthcare provider before using nitroglycerin topical?

You should not use this medication if you are allergic to nitroglycerin, isosorbide mononitrate (Imdur), or isosorbide dinitrate (BiDil, Isordil).

Before using nitroglycerin topical, tell your doctor if you are allergic to any drugs, or if you have:

  • congestive heart failure;

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

  • low blood pressure;

  • glaucoma; or

  • anemia (lack of red blood cells).

If you have any of these conditions, you may need a dose adjustment or special tests to safely use nitroglycerin topical.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

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

If you need to have any type of surgery or dental work, tell the surgeon or dentist ahead of time that you are using nitroglycerin topical.

How should I use nitroglycerin topical?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the directions on your prescription label.

Do not use nitroglycerin topical to treat an angina attack that has already begun. It will not work fast enough. Your doctor may prescribe an oral form of nitroglycerin (tablet, capsule, spray) to treat an angina attack. Talk with your doctor if any of your medications do not seem to work as well in treating or preventing angina attacks.

Nitroglycerin ointment is usually applied 3 or 4 times daily. You may also need to wash off the ointment at a certain time each day. Follow your doctor's instructions carefully.

Wash your hands after applying nitroglycerin ointment.

Do not stop using this medication without your doctor's advice, even if you feel better. You may have increased angina attacks if you stop using the medication suddenly.

Store this medication at room temperature, away from moisture and heat.

What happens if I miss a dose?

Apply the medicine as soon as you remember. If your next dose is less than 2 hours away, wait until then to apply the ointment and skip the missed dose.

Do not use extra ointment to make up a missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

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, seizure (convulsions), or blue-colored skin, lips, or nails.

What should I avoid while using nitroglycerin topical?

Avoid using nitroglycerin topical on irritated or broken skin.

Nitroglycerin topical 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 getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid drinking alcohol. It can increase some of the side effects of nitroglycerin topical.

Nitroglycerin topical 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:

  • worsening chest pain, slow heart rate;

  • feeling like you might pass out;

  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

  • fast or pounding heartbeats; or

  • blurred vision and dry mouth.

Less serious side effects may include:

  • mild skin rash or itching;

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

  • nausea, vomiting, upset stomach; or

  • feeling nervous, weak, or dizzy.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. 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 topical?

Tell your doctor about all other medications you use, especially:

  • blood pressure medication or diuretics (water pills);

  • cold or allergy medicines, diet pills, or over-the-counter pain medicine such as ibuprofen (Advil, Motrin) or naproxen (Aleve);

  • an erectile dysfunction medication such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra);

  • migraine headache medication such as ergotamine (Ergomar, Cafergot), or dihydroergotamine (D.H.E. 45, Migranal Nasal Spray);

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

  • a calcium channel blocker such as amlodipine (Norvasc), diltiazem (Tiazac, Cartia, Cardizem), felodipine (Plendil), nicardipine (Cardene), nifedipine (Procardia, Adalat), nimodipine (Nimotop), nisoldipine (Sular), or verapamil (Calan, Covera, Isoptin, Verelan).

This list is not complete and there may be other drugs that can interact with nitroglycerin topical. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about nitroglycerin topical.
  • 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: 1.04. Revision Date: 2010-12-15, 5:01:39 PM.

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