Side Effects of Nitrostat (nitroglycerin)

Nitrostat (nitroglycerin) is a nitrate used before physical activities (such as exercise, sexual activity) to prevent chest pain (angina) in people with coronary artery disease. 

It may also be used to relieve chest pain in these people once it occurs. Angina occurs when the heart muscle is not getting enough blood. Nitrostat works by relaxing and widening blood vessels so blood can flow more easily to the heart.

Common side effects of Nitrostat include

• headache,
• dizziness,
• lightheadedness,
• nausea,
• flushing, and
• burning/tingling under the tongue. 

Serious side effects of Nitrostat include

• fainting and
• fast/irregular/pounding heartbeat.

Drug interactions of Nitrostat include drugs to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), riociguat, rosiglitazone, and certain drugs to treat migraine headaches (ergot alkaloids such as ergotamine). 

During pregnancy, Nitrostat should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if Nitrostat passes into breast milk or if it may harm a nursing infant. Consult your doctor before breastfeeding.

Common side effects include:

• headache and
• lightneadedness

Aspirin, acetaminophen (Tylenol and others), or ibuprofen (Advil, Motrin, Nuprin, and others) may be used to relieve the pain.

Other side effects include:

• Nausea
• Vomiting
• Fainting
• Blurred vision

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.

The following adverse reactions are discussed in more detail elsewhere in the label:

• Hypotension
• Headache
• Hypersensitivity

Vertigo, dizziness, weakness, palpitation, and other manifestations of postural hypotension may develop occasionally, particularly in erect, immobile patients. Marked sensitivity to the hypotensive effects of nitrates (manifested by nausea, vomiting, weakness, diaphoresis, pallor, and collapse) may occur at therapeutic doses. Syncope due to nitrate vasodilatation has been reported.

Flushing, drug rash, and exfoliative dermatitis have been reported in patients receiving nitrate therapy.

PDE-5-Inhibitors And sGC-Stimulators

Nitrostat is contraindicated in patients who are using a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE-5). PDE-5-Inhibitors such as avanafil, sildenafil, vardenafil, and tadalafil have been shown to potentiate the hypotensive effects of organic nitrates.

Nitrostat is contraindicated in patients who are taking soluble guanylate cyclase (sGC) stimulators. Concomitant use can cause hypotension.

The time course and dose dependence of these interactions have not been studied, and use within a few days of one another is not recommended. Appropriate supportive care for the severe hypotension has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion.

Ergotamine

Oral administration of nitroglycerin markedly decreases the first-pass metabolism of dihydroergotamine and subsequently increases its oral bioavailability. Ergotamine is known to precipitate angina pectoris. Therefore, patients receiving sublingual nitroglycerin should avoid ergotamine and related drugs or be monitored for symptoms of ergotism if this is not possible.