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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). This medicine will not treat an angina attack that has already begun.

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

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

You should not use nitroglycerin topical if you are using medicine to treat pulmonary arterial hypertension (PAH), such as riociguat, (Adempas), sildenafil (Revatio), or tadalafil (Adcirca).

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Do not take erectile dysfunction medicine (Viagra, Cialis, and others) while you are using nitroglycerin topical, or you could have a sudden and serious decrease in blood pressure.

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

You should not use this medicine if you are allergic to nitroglycerin or other nitrates (isosorbide mononitrate, isosorbide dinitrate), or:

  • if you are using medicine to treat pulmonary arterial hypertension (PAH), such as riociguat (Adempas), sildenafil (Revatio), or tadalafil (Adcirca).

Do not take erectile dysfunction medicine (Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil, vardenafil) while you are using nitroglycerin topical. Using erectile dysfunction medicine with nitroglycerin can cause a sudden and serious decrease in blood pressure.

To make sure nitroglycerin is safe for you, tell your doctor 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).

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 medicine.

It is not known whether nitroglycerin topical passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use nitroglycerin topical?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Nitroglycerin topical 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.

Nitroglycerin topical will not work fast enough to treat an angina attack that has already begun. 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 medicines do not seem to work as well in treating or preventing angina attacks.

Wash your hands after applying this medicine.

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.

Do not stop using nitroglycerin topical suddenly, even if you feel fine. Stopping suddenly may cause increased angina attacks. Follow your doctor's instructions about tapering your dose.

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

What happens if I miss a dose?

Apply 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 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 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:

  • worsening chest pain, slow heart rate;

  • a light-headed feeling, like you might pass out; or

  • pale or blue colored appearance in your fingers or toes.

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

Common side effects may include:

  • flushing (warmth, redness, or tingly feeling);

  • headache; or

  • dizziness.

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:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Use: Treatment of angina pectoris in patients who have not responded to sublingual nitroglycerin and beta-blockers.


LINGUAL SPRAY:
1 to 2 sprays (0.4 to 0.8 mg) on or under tongue every 5 minutes as needed, up to 3 sprays in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to inhale or swallow this medication.

Use: Acute relief of an anginal attack.


SUBLINGUAL TABLET:
0.3 to 0.6 mg sublingually or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended

Comments:
-Administer while sitting down due to rapid onset.
-Advise patient not to chew or swallow this medication.

Use: Acute relief of an anginal attack.

Usual Adult Dose for Angina Pectoris Prophylaxis:

LINGUAL SPRAY:
1 to 2 sprays (0.4 to 0.8 mg) on or under tongue 5 to 10 minutes prior to activity that might precipitate an acute attack

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to inhale or swallow this medication.


SUBLINGUAL TABLET:
0.3 to 0.6 mg sublingually or in the buccal pouch 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to chew or swallow this medication.


TOPICAL OINTMENT:
1/2 inch (7.5 mg) topically upon rising and 1/2 inch (7.5 mg) 6 hours later; titrate as needed and tolerated

Comments:
-Clinical trial doses have ranged from 1/2 to 2 inches (7.5 to 30 mg) applied to 36 square inches of truncal skin.
-Ointment should be applied to a dry and hairless area of the trunk.


TRANSDERMAL PATCH:
0.2 to 0.4 mg/hr patch applied topically once a day for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr

Comments:
-Patch should be applied to a dry and hairless area of the upper arm or body; rotate application sites to avoid skin irritation.
-Doses between 0.4 and 0.8 mg/hr have shown continued effectiveness for 10 to 12 hours daily for at least 1 month of intermittent administration.


EXTENDED RELEASE CAPSULE:
2.5 to 6 mg orally 3 to 4 times a day; titrate as needed and tolerated

Comments:
-Subjects were titrated up to 26 mg four times a day in one clinical trial.

Usual Adult Dose for Myocardial Infarction:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Use: Control of congestive heart failure in the setting of acute myocardial infarction.

Usual Adult Dose for Hypertension:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Uses:
-Treatment of perioperative hypertension.
-Induction of intraoperative hypotension.

Usual Adult Dose for Anal Fissure and Fistula:

RECTAL OINTMENT:
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

Comments:
-A finger covering such as plastic wrap, a disposable surgical glove, or a finger cot should be placed on the finger to apply ointment.
-Insert finger no further than first finger joint and apply around side of anal canal; if unable to insert finger due to pain, apply directly to outside of anus.

Use: Treatment of moderate to severe pain associated with chronic anal fissure.

What other drugs will affect nitroglycerin topical?

Other drugs may interact with nitroglycerin topical, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

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: 2.01. Revision Date: 2014-11-17, 11:58:29 AM.

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