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- What is nitroglycerin?
- What are the uses for nitroglycerin?
- What are the side effects of nitroglycerin?
- What is the dosage for nitroglycerin?
- Which drugs or supplements interact with nitroglycerin?
- Is nitroglycerin safe to use during pregnancy or while breastfeeding?
- What else should I know about nitroglycerin?
What is nitroglycerin?
What brand names are available for nitroglycerin?
- Nitronol, and others
Is nitroglycerin available as a generic drug?
Yes (for some dosage forms)
Do I need a prescription for nitroglycerin?
What are the uses for nitroglycerin?
Nitroglycerin is used for the treatment and prevention of angina caused by coronary artery disease. Sublingual nitroglycerin and nitroglycerin spray are used to treat acute anginal attacks. Transdermal nitroglycerin, nitroglycerin ointment and capsules do not act rapidly enough to be used for acute anginal attacks.
What are the side effects of nitroglycerin?
Common side effects include:
- headache and
Other side effects include:
More serious side effects include flushing of the head and neck can occur with nitroglycerin therapy as can an increase in heart rate or palpitations. This can be associated with a drop in blood pressure which can be accompanied by dizziness or weakness. To reduce the risk of low blood pressure, patients often are told to sit or lie down during and immediately after taking nitroglycerin.
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What is the dosage for nitroglycerin?
For the treatment of acute angina attacks or for acute prevention (for example, immediately before encountering situations likely to bring on an anginal attack), one tablet is allowed to dissolve under the tongue or between the cheek and gums, or one spray is given of the lingual spray. Sublingual, spray and buccal nitroglycerin are rapidly absorbed from the lining of the mouth for immediate effects. This may be repeated every 5 minutes as needed. If angina is not relieved after a total of 3 doses, the patient should be taken to a hospital or a doctor should be contacted. If lingual spray is used, the canister of spray should not be shaken prior to use, and it should be sprayed onto or under the tongue and then the mouth closed.
For prevention of angina, ointment may be applied using special dose-measuring application papers provided with the ointment. The usual dose is 1/2 to 2 inches applied every 4-6 hours. The appropriate amount of ointment is squeezed as a thin layer onto the paper, and the paper is used to spread the ointment onto a non-hairy area of the skin. The ointment should not be allowed to come into contact with the hands where it can be absorbed.
Transdermal patches also are used for prevention. The usual dose is 0.2-0.8 mg/hr applied for 12 hours and then removed. An additional 12 hours should be allowed before applying the next patch because a 12 hour nitroglycerin free period reduces the occurrence of tolerance to the effects (reduced effectiveness) of nitroglycerin. Patches may be applied to any hairless site but should not be applied to areas with cuts or calluses which can alter absorption. Firm pressure should be used over the patch to ensure contact with the skin. The patch should not be cut or trimmed. Patches are waterproof and should not be affected by showering or bathing.
Capsules of long-acting nitroglycerin also are used for prevention. The usual dose is 2.5-9 mg administered 2 to 3 times per day 1 to 2 hours after a meal. Capsules should be swallowed whole and not chewed.
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Which drugs or supplements interact with nitroglycerin?
- treat high blood pressure,
- some antidepressants;
- some anti-psychotics,
- quinidine (Quinaglute, Quinidex),
- procainamide (Pronestyl, Procan-SR, Procanbid),
- benzodiazepines such as diazepam (Valium), or
- opiates, for example, morphine.
Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) exaggerate the blood pressure lowering effects of nitroglycerin and may cause excessive blood pressure reduction. Patients taking nitrates should not take sildenafil, tadalafil, vardenafil, or avanafil.
Ergot alkaloids, for example, ergotamine with caffeine-rectal (Cafergot, Migergot), and sumatriptan (Imitrex) can oppose the vasodilatory actions of nitroglycerin and may cause angina. A similar effect can occur with ephedrine and the decongestants pseudoephedrine (Sudafed) and propanolamine which is contained in many drugs used for treating the symptoms of colds.
Is nitroglycerin safe to use during pregnancy or while breastfeeding?
Nitroglycerin has not been adequately studied in pregnant women.
It is not known if nitroglycerin is secreted in breast milk.
What else should I know about nitroglycerin?
What preparations of nitroglycerin are available?
- Tablets: 0.3, 0.4, 0.6 mg;
- Capsules: 2.5, 6.5, 9 mg; Spray: 0.4 mg/spray;
- Transdermal Patch: 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hour;
- Ointment: 2%;
- Infusion Solution: 25, 50, 100 mg/250 ml
- Injectable solution: 5 mg/ml.
How should I keep nitroglycerin stored?
All formulations should be kept at room temperature, 15 C to 30 C (59 F to 86 F). The sublingual tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of the greater moisture in these rooms. Care should be taken to replace the sublingual tablets every six months.
How does nitroglycerin work?
Blood returning from the body in the veins must be pumped by the heart through the lungs and into the arteries against the high pressure in the arteries. In order to accomplish this work, the heart's muscle must produce and use energy ("fuel"). The production of energy requires oxygen. Angina pectoris (angina) or "heart pain" is due to an inadequate flow of blood (and oxygen) to the muscle of the heart. It is believed that all nitrates, including nitroglycerin, have their effects by dilating (widening) the arteries and veins throughout the body. In patients with angina, nitroglycerin preferentially dilates blood vessels that supply the areas of the heart where there is not enough blood flow and oxygen thereby delivering oxygen to the heart muscle that needs it most. In addition, blood is redistributed to the body within the widened veins, and this reduces the amount of blood returning to the heart that needs to be pumped. Therefore, the heart has less work to do and requires less blood and oxygen. Dilation of the arteries also lowers the pressure in the arteries against which the heart must pump. As a consequence, the heart works even less and requires less blood and oxygen.
When was nitroglycerin approved by the FDA?
Synthesized in 1846, nitroglycerin was first used to treat anginal attacks in 1879. It was granted FDA approval in 1938.
Nitroglycerin, nitroglycerin translingual, nitroglycerin transdermal, nitroglycerin intravenous, nitroglycerin topical (Nitrostat, Nitroquick, Nitrolingual, Nitro-Dur, Minitran, Nitro-Bid and others) is a nitrate used for the treatment of angina (heart pain). Review side effects, drug interactions, warnings and precautions, and safety during pregnancy information prior to taking this medication.
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Related Disease Conditions
Angina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
Heart Attack (Myocardial Infarction)
A heart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
Mitral Valve Prolapse
Mitral valve prolapse (MVP), also called "click murmur syndrome" and "Barlow's syndrome," is the most common type of heart valve abnormality. Usually, people with mitral valve prolapse have no signs and symptoms; however, if the prolapsed valve is severe, symptoms may appear. When symptoms of severe mitral valve prolapse do appear, they may include, fatigue, palpitations, chest pain, anxiety, migraine headaches, and pulmonary edema. Echocardiography is the most useful test for mitral valve prolapse. Most people with mitral valve need no treatment. However, if the valve prolapse is severe, treatment medications or surgery may be necessary to repair the heart valve.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Congestive Heart Failure (CHF) Symptoms, Treatment, and Life Expectancy
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Portal hypertension is most commonly caused by cirrhosis, a disease that results from scarring of the liver. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, and a parasitic infection called schistosomiasis. Symptoms of portal hypertension include varices (enlarged veins), vomiting blood, blood in the stool, black and tarry stool, ascites (abnormal fluid collection within the peritoneum, the sac that contains the intestines within the abdominal cavity), confusion and lethargy, splenomegaly or enlargement of the spleen, and decreased white blood cell counts.
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Heart Attack Treatment
A heart attack involves damage or death of part of the heart muscle due to a blood clot. The aim of heart attack treatment is to prevent or stop this damage to the heart muscle. Heart attack treatments included medications, procedures, and surgeries to protect the heart muscle against injury.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include: Smoking High blood pressure High cholesterol Diabetes Family history Obesity Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are two types of aortic dissection, type 1 and type 2. Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Treatment depends on the type of aortic dissection, and the severity of the tear in the aorta.
Dizziness is a symptom that often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and other medical conditions. Treatment of dizziness depends on the cause.
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