Nitroglycerin Tablets, Capsules, and Sprays (patient information)

Why this medication is prescribed

Nitroglycerin is used to prevent chest pain (angina). It works by relaxing the blood vessels to the heart, so the blood flow and oxygen supply to the heart is increased.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How this medication should be used

Nitroglycerin comes as a sublingual tablet, buccal tablet, extended-release (long-acting) capsule, or spray to be used orally. The buccal extended-release tablets and the extended-release tablets and capsules are usually taken three to six times a day. Do not crush, chew, or divide the extended-release tablets or capsules. The sublingual tablet and spray are used as needed to relieve chest pain that has already started or to prevent pain before activities known to provoke attacks (e.g., climbing stairs, sexual activity, heavy exercise, or cold weather). The buccal extended-release tablets also may be used during an attack and just before situations known to provoke attacks. 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 controls chest pain but does not cure it. Continue to use nitroglycerin even if you feel well. Do not stop taking nitroglycerin without talking to your doctor. Stopping the drug abruptly may cause chest pain.

Nitroglycerin can lose its effectiveness when used for a long time. This effect is called tolerance. If your angina attacks happen more often, last longer, or are more severe, call your doctor.

If you are using the buccal extended-release tablet, place the tablet between your cheek and gum and allow it to dissolve. Do not chew or swallow it. If you feel dizzy, sit down after placing the tablet in your mouth. Try not to swallow saliva until the tablet dissolves. Buccal extended-release tablets start to work within 2-3 minutes. To make the tablet dissolve faster, touch it with your tongue before placing it in your mouth or drink a hot liquid. If an attack occurs while you have a buccal extended-release tablet in place, place a second tablet on the opposite side of your mouth. If chest pain persists, use sublingual tablets, call for emergency assistance, or go to a hospital emergency department immediately.

If you are taking nitroglycerin sublingual tablets or spray for acute chest pain, you should carry the tablets and spray with you at all times. Sit down when an acute attack occurs. The drug starts to work within 2 minutes and goes on working for up to 30 minutes. If you are taking nitroglycerin tablets and your chest pain is not relieved within 5 minutes, take another dose. If you are using nitroglycerin spray and your chest pain is not relieved in 3-5 minutes, repeat the process. Call for emergency assistance or go to a hospital emergency department if pain persists after you have taken three tablets (at 5-minute intervals) or have used three sprays (at 3-5 minute intervals) and 15 minutes have passed.

To use the tablets, place a tablet under your tongue or between your cheek and gum and allow it to dissolve. Do not swallow the tablet. Try not to swallow saliva too often until the tablet dissolves.

To use the spray, follow these steps:

1. Do not shake the drug container. Hold it upright with the opening of the spray mechanism as close as possible to your opened mouth.
2. Press the spray mechanism with your forefinger to release the spray. Spray the drug onto or under your tongue and close your mouth immediately. Do not inhale or swallow the spray.

Other uses for this medicine

Nitroglycerin tablets also are used with other drugs to treat congestive heart failure and heart attacks. Talk to your doctor about the possible risks of using this drug for your condition.

Special precautions

Before taking nitroglycerin:

• tell your doctor and pharmacist if you are allergic to nitroglycerin, isosorbide (Imdur, Isordil, Sorbitrate), or any other drugs.
• tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially aspirin; beta blockers such as atenolol (Tenormin), carteolol (Cartrol), labetalol (Normodyne, Trandate), metoprolol (Lopressor), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), and timolol (Blocadren); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem), felodipine (Plendil), isradipine (DynaCirc), nifedipine (Procardia), and verapamil (Calan, Isoptin); dihydroergotamine (D.H.E. 45); sildenafil (Viagra); and vitamins.
• tell your doctor if you have low red blood cell counts (anemia), glaucoma, or recent head trauma.
• 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.
• you should know that this drug may make you drowsy or dizzy. Do not drive a car or operate machinery until you know how it affects you.
• ask your doctor about the safe use of alcoholic beverages while you are taking nitroglycerin. *Alcohol can make the side effects from nitroglycerin worse.

Special dietary instructions

Take nitroglycerin extended-release tablets and capsules on an empty stomach with a full glass of water.

What to do if you forget a dose

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.

Side Effects

Minor Side Effects

Side effects from nitroglycerin are common. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• rash
• dizziness
• upset stomach
• flushing (feeling of warmth)

Severe Side Effects

If you experience any of the following symptoms, call your doctor immediately:

• blurred vision
• dry mouth
• chest pain
• fainting

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

Storage conditions needed for 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). Avoid puncturing the spray container and keep it away from excess heat. Do not open a container of sublingual nitroglycerin until you need a dose. Do not use tablets that are more than 12 months old. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/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.

Other information

Keep all appointments with your doctor and the laboratory. Nitroglycerin extended-release capsules should not be used for acute angina attacks. Continue to use nitroglycerin tablets or spray to relieve chest pain that has already started.

If headache continues, ask your doctor if you may take acetaminophen. Your nitroglycerin dose may need to be adjusted. Do not take aspirin or any other medication for headache while taking nitroglycerin unless your doctor tells you to.

The tablets may cause a sweet, tingling sensation when placed under your tongue. This sensation is not an accurate indicator of drug strength; the absence of a tingling sensation does not mean that the drug is not working.

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

Brand names

• Nitro-Bid®
• Nitrogard®
• Nitroglycerin Slocaps®
• Nitrolingual® Pumpspray
• NitroQuick®
• Nitrostat®
• Nitrotab®
• Nitro-Time®