Nitroglycerin

Brand Name(s):

• Nitromist
• Nitrostat®
• Nitro-Time®

WHY is this medicine prescribed?

Nitroglycerin spray and tablets are used to treat episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). The spray and tablets may also be taken just before activities that may cause episodes of angina in order to prevent the angina from occurring. Nitroglycerin extended-release (long-acting) capsules are used to prevent episodes of angina in people who have coronary artery disease. The extended-release capsules can only be used to prevent angina attacks; they cannot be used to treat an attack once it has begun. Nitroglycerin is in a class of medications called vasodilators. It works by relaxing the blood vessels so the heart does not need to work as hard and therefore does not need as much oxygen.

HOW should this medicine be used?

Nitroglycerin comes as a sublingual tablet, an extended-release (long-acting) capsule, and a spray. The extended-release capsules are usually taken by mouth three to four times a day. The tablets and spray are usually taken as needed, either 5-10 minutes before activities that may cause attacks of angina or at the first sign of an attack. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nitroglycerin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Nitroglycerin extended-release capsules help prevent angina but do not cure coronary artery disease. Continue to take nitroglycerin capsules even if you feel well. Do not stop taking nitroglycerin capsules without talking to your doctor.

Nitroglycerin may not work as well after you have used it for some time or if you have taken many doses. If you are taking the capsules, your doctor will schedule your doses so that there is a period of time when you are not exposed to nitroglycerin every day. If you are taking the tablets or spray, you should take the fewest tablets or use the fewest number of sprays needed to relieve the pain of your attacks. If your angina attacks happen more often, last longer, or become more severe at any time during your treatment, call your doctor.

Talk to your doctor about how to use nitroglycerin tablets or spray to treat angina attacks. Your doctor will probably tell you to sit down and take one dose of nitroglycerin when an attack begins. If your symptoms do not improve very much or if they worsen after you take this dose you may be told to call for emergency medical help right away. If your symptoms do not go away completely after you take the first dose, your doctor may tell you to take a second dose after 5 minutes have passed and a third dose 5 minutes after the second dose. Call for emergency medical help right away if your chest pain has not gone away completely 5 minutes after you take the third dose.

Do not chew or swallow nitroglycerin tablets. Instead, place the tablet under your tongue or between your cheek and gum and wait for it to dissolve. You may feel burning or tingling in your mouth as the tablet dissolves. This is normal but is not a sign that the tablet is working. Do not be concerned that the tablet is not working if you do not feel the burning or tingling.

To use the spray, follow these steps:

• Sit down if possible, and hold the container without shaking it. Remove the plastic cap.
• If you are using the container for the first time, hold the container upright so that it is pointed away from yourself and others, and press the button 10 times to prime the container. If you are not using the container for the first time but have not used it in 6 weeks or longer, press the button 2 times to re-prime the container.
• Open your mouth. Hold the container upright, as close to your mouth as possible.
• Use your forefinger to press the button firmly. This will release a spray into your mouth. Do not inhale the spray.
• Close your mouth. Do not spit out the medication or rinse your mouth for 5-10 minutes.
• Replace the plastic cap on the container.
• Check the level of liquid in the container from time to time to be sure that you will always have enough medication on hand. Hold the container upright while you are checking. If the liquid reaches the top or middle of the hole on the side of the container, you should order more medication. If the liquid is at the bottom of the hole, the container will no longer dispense full doses of medication.

Do not try to open the container of nitroglycerin spray. This product may catch fire, so do not use near an open flame, and do not allow the container to be burned after use.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What SPECIAL PRECAUTIONS should I follow?

Before taking or using nitroglycerin,

• tell your doctor and pharmacist if you are allergic to nitroglycerin patches, capsules, tablets, ointment, or spray; any other medications; or any of the ingredients in nitroglycerin tablets, capsules, or spray. Ask your pharmacist for a list of the ingredients.
• tell your doctor if you are taking phosphodiesterase inhibitors (PDE-5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Your doctor may tell you not to take nitroglycerin.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: aspirin; beta blockers such as atenolol (Tenormin), carteolol , labetalol (Trandate), metoprolol (Lopressor), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), and timolol; calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem), felodipine (Plendil), isradipine (DynaCirc), nifedipine (Procardia), and verapamil (Calan, Isoptin); ergot-type medications such as bromocriptine (Parlodel), cabergoline, dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (Cafergot), methylergonovine (Methergine), methysergide (Sansert), and pergolide (Permax); heparin; medications for high blood pressure or heart failure; Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• you should know that nitroglycerin products may not dissolve easily in your mouth if you are taking medications that cause dry mouth such as antihistamines; antidepressants including amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); ipratropium (Atrovent); or medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems. If this happens, use an artificial saliva product or chew gum to increase the amount of saliva in your mouth so that the tablet will dissolve.
• tell your doctor if you have recently had a heart attack and if you have anemia (low number of red blood cells) or any condition that causes increased pressure in your skull. Your doctor may tell you not to take nitroglycerin.
• tell your doctor if you think you may be dehydrated and if you have or have ever had heart failure, low blood pressure, or hypertrophic cardiomyopathy (thickening of the heart muscles).
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking nitroglycerin, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking nitroglycerin.
• ask your doctor about the safe use of alcoholic beverages while you are taking nitroglycerin. Alcohol can make the side effects from nitroglycerin worse.
• you should know that nitroglycerin may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position, or at any time, especially if you have been drinking alcoholic beverages. To avoid this problem, get up slowly, resting your feet on the floor for a few minutes before standing up. Take extra precautions to avoid falling during your treatment with nitroglycerin.
• you should know that you may experience headaches during your treatment with nitroglycerin. These headaches may be a sign that the medication is working as it should. Do not try to change the times that you take nitroglycerin in order to avoid headaches because then the medication may not work as well.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Nitroglycerin tablets and spray are usually taken as needed. If you miss a dose of nitroglycerin extended-release capsules, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

What should I do in case of OVERDOSE?

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• headache
• confusion
• fever
• dizziness
• slow or pounding heartbeat
• nausea
• vomiting
• bloody diarrhea
• fainting
• shortness of breath
• sweating
• flushing
• cold, clammy skin
• loss of ability to move the body
• coma (loss of consciousness for a period of time)
• seizures

What OTHER INFORMATION should I know?

Keep all appointments with your doctor

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking nitroglycerin.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

AHFS® Consumer Medication Information. © Copyright, The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: August 1, 2010.