Generic Name: nitroglycerin (NYE troe GLI ser in)
Brand Names: Nitro-Time, Nitrolingual, NitroMist, Nitrostat

What is NitroMist?

NitroMist (nitroglycerin sublingual spray) belongs to 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.

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

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

Important information

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

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

Before taking this medicine

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

Do not use NitroMist 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 NitroMist 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 NitroMist, 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 NitroMist 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 NitroMist without telling your doctor if you are breast-feeding a baby.

See also: Pregnancy and breastfeeding warnings (in more detail)

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

How should I take NitroMist?

Use NitroMist 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. NitroMist can cause dizziness or fainting.

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

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 NitroMist. 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.

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

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

NitroMist 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 NitroMist, such as dizziness, drowsiness, feeling light-headed, or fainting.

NitroMist side effects

Get emergency medical help if you have any of these signs of an allergic reaction to NitroMist: 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 NitroMist side effects may include:

  • 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)

What other drugs will affect NitroMist?

Many drugs can interact with NitroMist. 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 NitroMist. 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 NitroMist.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use NitroMist 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 1996-2014 Cerner Multum, Inc. Version: 12.01. Revision Date: 8/12/2011 2:55:37 PM.