- A Visual Guide to Heart Disease
- Medical Illustrations of the Heart Image Collection
- Take the Heart Disease Quiz!
- What is nitroglycerin?
- What brand names are available for nitroglycerin?
- Is nitroglycerin available as a generic drug?
- Do I need a prescription for nitroglycerin?
- Why is nitroglycerin prescribed to patients?
- 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?
Why is nitroglycerin prescribed to patients?
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.
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.
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 XYZ 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). Side effects, drug interactions, warnings and precautions, and safety during pregnancy information should be reviewed prior to taking this medication.
Multimedia: Slideshows, Images & Quizzes
Heart Disease: Causes of a Heart Attack
Learn about heart disease and heart attack symptoms and signs of a heart attack in men and women. Read about heart disease...
Heart Disease Quiz: Test Your Medical IQ
Take our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes,...
Heart Disease: Symptoms, Signs, and Causes
What is heart disease (coronary artery disease)? Learn about the causes of heart disease. Symptoms of heart disease include chest...
Related Disease Conditions
Pulmonary edema (swelling or fluid in the lungs) can either be caused by cardiogenic causes (congestive heart failure, heart...
12 Congestive Heart Failure Symptoms, Stages, Causes, and Life Expectancy
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease,...
Dizziness is a symptom that often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness...
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to...
A heart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart...
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and...
Angina (Symptoms, Causes, Types, Diagnosis, and Treatment)
Angina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning,...
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy,...
Mitral Valve Prolapse (Syndrome, Symptoms, Causes, Treatment, Surgery)
Mitral valve prolapse (MVP), also called "click murmur syndrome" and "Barlow's syndrome," is the most common type of heart valve...
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in...
Portal hypertension is most commonly caused by cirrhosis, a disease in which results from scarring of a liver injury. Other...
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are...
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...
Treatment & Diagnosis
- Heart Disease FAQs
- Medication Disposal
- Dangers of Mixing Medications
- Viagra - Impotence Treatment Update
- Viagra and Nitrates Don't Mix
- How To Reduce Your Medication Costs
- Pharmacy Visit, How To Get The Most Out of Your Visit
- Indications for Drugs: Approved vs. Non-approved
- Drugs: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- Generic Drugs, Are They as Good as Brand-Names?
Medications & Supplements
Prevention & Wellness
- Male Sexual Enhancement Supplements Often Ineffective, Possibly Harmful: Study
- Researchers: Retract Study That Claimed Nitroglycerin Might Boost Bone Density
- Drug May Ease Angina in People With Type 2 Diabetes
- Exercise Safety Tips for People With Heart Disease
- Cardiac Cocktail Delivered by Paramedics May Save Lives
- FDA OKs Impotence Drug Cialis to Treat Enlarged Prostate
- Nitroglycerin May Increase Bone Density
Healthy Heart Resources
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.