nitroglycerin

nitroglycerin

Generic Name: nitroglycerin (oral/buccal/sublingual/spray) (NYE troe GLI ser in)
Brand names: Nitrolingual, Nitroquick, 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 other 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). 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). Serious, life-threatening side effects can occur if you take nitroglycerin while you are using sildenafil. You should not use this medication if you are allergic to nitroglycerin, isosorbide mononitrate (Imdur), or isosorbide dinitrate (BiDil, Isordil), or 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);





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

a brain injury, hemorrhage, or tumor.

Before taking nitroglycerin, 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;

migraine headaches;

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






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 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 this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. 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.

The nitroglycerin buccal tablet should be placed between your cheek and gum and allowed to dissolve slowly. Do not chew or swallow it.






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 tablet or 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. 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.





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





It is important to 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 nitroglycerin 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 often used only as needed, you may not be on a dosing schedule. If you are using the medication regularly, use the missed dose as soon as you remember. If your next dose is less than 2 hours away, skip the missed dose and use the medicine at your next regularly scheduled time. Do not use 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. 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. Stop using nitroglycerin and call your doctor at once if you have any of these serious side effects:





fast, slow, pounding, or uneven heart rate;

blurred vision or dry mouth;

feeling light-headed, nausea, vomiting, sweating, pale skin fainting; 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. Tell your doctor about any unusual or bothersome side effect.




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 Pediatric Dose for not applicable:







>1 year:

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?

Before taking nitroglycerin, tell your doctor if you are using any of the following drugs:





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 erectile dysfunction medication such as tadalafil (Cialis) or vardenafil (Levitra);





antidepressants such as amitriptyline (Elavil, Etrafon), 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 may be other drugs that can interact with nitroglycerin. 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.
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.