Nitroglycerin

What is Nitroglycerin?

Nitroglycerin is used to treat chest pain, or angina pectoris (ischemic heart disease). It is available in tablets, capsules, ointment, solution for intravenous use, transdermal patches (placed on the skin), or sprays administered sublingually (held under the tongue).

The patch and the ointment are for prevention of chest pain.

In the form of sublingual (held under the tongue) or buccal (held in the cheek) tablets, or in oral spray (sprayed on or under the tongue), nitroglycerin helps relieve chest pain that has already occurred. The spray can also prevent anginal pain. The type of nitroglycerin you use will depend on your condition.

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

Nitroglycerin may cause severe low blood pressure (possibly marked by dizziness or light-headedness), especially if you are in an upright position or have just gotten up from sitting or lying down. You may also find your heart rate slowing and your chest pain increasing. People taking diuretic medication (water pills), or who have low systolic blood pressure (less than 90 mm Hg), should use nitroglycerin with caution. This effect may be more frequent in patients who have also consumed alcohol.

Since nitroglycerin can cause dizziness, you should observe caution while driving, operating machinery, or performing other tasks that demand concentration.

Nitroglycerin tablets lose their effectiveness when exposed to air. If you are taking sublingual (held under the tongue) nitroglycerin, you may notice a burning or tingling sensation. This does not necessarily mean that tablets that have been exposed to air for a long period of time are still effective.

Daily headaches sometimes accompany treatment with nitroglycerin. Patients should resist the temptation to avoid headaches by altering the schedule of their treatment with nitroglycerin, since loss of headache may be associated with simultaneous loss of efficacy.

To avoid tooth and gum decay, vary location sites and brush your teeth after the tablet has completely dissolved.

Do not fall asleep with a tablet in your mouth.

Who should not take Nitroglycerin?

Do not take nitroglycerin if you are allergic to the medication or any of its ingredients.

The capsule form should not be used if you have closed-angle glaucoma (pressure in the eye). Do not take nitroglycerin spray if you are currently taking a phosphodiesterase type 5 inhibitor (such as Viagro) for erectile dysfunction; the concominant use of these 2 medications may cause postural hypotension (dizziness upon standing up).

Do not use nitroglycerin patches if you are allergic to the adhesive.

What should I tell my doctor before I take the first dose of Nitroglycerin?

Tell your doctor about all prescription, over-the-counter, and herbal medications you are taking before beginning treatment with nitroglycerin. Also, talk to your doctor about your complete medical history, especially if you have had a recent heart attack, head injury, or stroke; or if you have anemia, low blood pressure, glaucoma (pressure in the eye), or heart, kidney, liver, or thyroid disease.

What is the usual dosage?

The information below is based on the dosage guidelines your doctor uses. Depending on your condition and medical history, your doctor may prescribe a different regimen. Do not change the dosage or stop taking your medication without your doctor's approval.

Adults: Sublingual or Buccal Tablets: At the first sign of chest pain, 1 tablet should be dissolved under the tongue or inside the cheek. You may repeat the dose every 5 minutes until the pain is relieved. If your pain continues after you have taken 3 tablets in a 15-minute period, notify your doctor or seek medical attention immediately. You may take sublingual or buccal nitroglycerin from 5 to 10 minutes before starting activities that may cause chest pain. Patch: A patch is applied to the skin for 12 to 14 hours. After this time, the patch is removed; it is not applied again for 10 to 12 hours (a "patch-off" period). Apply the patch as soon as you remove it from its protective pouch. Spray: At the first sign of chest pain, spray 1 or 2 premeasured doses onto or under the tongue. You should not use more than 3 sprays within a 15-minute period. If your chest pain continues, you should contact your doctor or seek medical attention immediately. The spray can be used 5 to 10 minutes before activity that might precipitate an attack, such as exercise. Ointment: The usual starting dose may be a daily total of 1 inch of ointment. Apply one-half inch on rising in the morning, and the remaining one-half inch 6 hours later. If needed, follow your doctor's instructions for increasing your dosage. Apply in a thin, uniform layer, regardless of the amount of your dosage. There should be a daily period where no ointment is applied. Usually, the "ointment-off" period will last from 10 to 12 hours. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. Absorption varies with site of application; more is absorbed through the chest. Sustained-Release Capsules or Tablets: The smallest effectiveamount should be taken 2 or 3 times a day at 8- to 12-hour intervals.

Children: The safety and effectiveness of nitroglycerin have not been established for children.

How should I take Nitroglycerin?

If you use a patch, dispose of it carefully. There is enough drug left in a used patch to be harmful to children and pets.

Nitroglycerin is available in many forms. It is extremely important for you to follow your doctor's directions for taking the type of nitroglycerin prescribed for you. Never interchange brands.

For changes in dosage and frequency of application consult your physician. Dosage instructions should be obtained from your physician.

Ointment: One appropriate dosing schedule for the ointment would begin with two daily 1/2 inch (7.5 mg) doses, one applied on rising in the morning and one applied six hours later. The foilpac is intended as a unit dose package only and is equivalent to approximately 1 inch as squeezed from the tube. Use entire contents of foilpac to obtain full dose and discard immediately after use.

To apply, measure desired dosage of Nitroglycerin Ointment 2% by means of the dose measuring applicator supplied with the tube. Place the applicator on a flat surface, printed side down. Squeeze the necessary amount of ointment from the tube onto the applicator, and place the applicator (ointment side down) on the desired area of the skin.

Spread the ointment using the dose measuring applicator lightly onto the chest or other areas of skin if preferred. Do not rub into the skin. Coverage of an area approximately the size of the dose measuring applicator (3 1/2′′ by 2 1/4′′) should be sufficient to obtain the desired clinical effects. A larger area may be used.

Tape the applicator into place. The ointment can stain clothing. Care should be taken to completely cover the dose measuring applicator with a plastic kitchen wrap.

Spray: At the first sign of chest pain, spray 1 or 2 premeasured doses onto or under the tongue. You should not use more than 3 sparys within a 15-minute period. If your chest pain continues, you should contact your doctor or seek medical attention immediately.

The spray can be used 5 to 10 minutes before activity that might precipitate an attack, such as exercise.

Patch: Nitroglycerin Patch comes with an additional patient leaflet. Read it carefully and reread it each time you get Nitroglycerin Patch refilled.

Nitroglycerin Patch is for external use only.

Wash your hands thoroughly before and after applying. Apply the patch to the chest, inner side of the upper arm, or shoulder. Clean and dry the skin before applying the patch. If necessary, hair may be removed by clipping.

Remove the patch from the package. Apply with a firm pressure to the skin. To avoid skin irritation, change the treatment site daily. Do not apply to irritated or damaged skin.

If the patch becomes loose, remove it and apply a new patch at a different site. After you remove the used patch, fold the sticky side together and throw away. This patch should only be worn for up to 12 to 14 hours a day, or as directed by your doctor, so that you will have a 10 to 12 hour "nitrate-free" period each day. Do not use more of Nitroglycerin Patch than prescribed. It is important to have a "nitrate-free" period of time each day for Nitroglycerin Patch to continue to work well and to decrease the risk of physical dependence.

Sublingual or Buccal Tablets: At the first sign of chest pain, 1 tablet should be dissolved under the tongue or inside the cheek. You may repeat the dose every 5 minutes until the pain is relieved. If your pain continues after you have taken 3 tablets in a 15-minute period, notify your doctor or seek medical attention immediately.

You may take sublingual or buccal nitroglycerin from 5 to 10 minutes before starting activities that may cause chest pain.

What should I avoid while taking Nitroglycerin?

Do not shake container before administering dose.

Daily headaches may be an indicator of the drug's activity. Do not change your dose to avoid the headache, because you may reduce the drug's effectiveness at the same time.

Avoid alcohol intake.

What are possible food and drug interactions associated with Nitroglycerin?

If Nitroglycerin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining nitroglycerin with the following: alcohol, alteplase, aspirin, blood vessel dilators such as Loniten, dihydroergotamine (D.H.E.), erectile dysfunction drugs such as Viagra, heart medications known as beta-blockers and calcium channel blockers, and salicylates.

What are the possible side effects of Nitroglycerin?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this drug.

Side effects may include: dizziness, flushed skin (neck and face), headache, heavy sweating, light-headedness, nausea, worsened angina (chest) pain

Can I receive Nitroglycerin if I am pregnant or breastfeeding?

The effects of nitroglycerin during pregnancy and breastfeeding are unknown. Tell your doctor immediately if you are pregnant, plan to become pregnant, or are breastfeeding.

What should I do if I miss a dose of Nitroglycerin?

If you are using a skin patch or ointment, apply it as soon as you remember. If it is almost time for your regular dose, skip the one you missed and go back to your regular schedule. Never apply 2 skin patches at the same time.

If you are taking oral tablets or capsules, never double your dose of nitroglycerin if you miss a dose. Skip the missed dose and return to your regular schedule

How should I store Nitroglycerin?

Keep nitroglycerin in the container it came in, tightly closed. Store it at room temperature. Do not refrigerate.

Avoid puncturing the spray container and keep it away from excess heat.

Do not open the container of sublingual tablets until you need a dose. Close the container tightly immediately after each use. Do not put other medications, a cotton plug, or anything else in the container.

Keep the sublingual tablets handy at all times. Keep the patches in the protective pouches they come in until use.