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All about: nitroglycerin oral/buccal/sublingual/spray

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Generic Name: nitroglycerin (oral/buccal/sublingual/spray) (nye troe GLI ser in)
Brand Names: Nitro-Time, Nitrocot, Nitrogard, Nitroglyn E-R, Nitrolingual, Nitroquick, Nitrostat

What is nitroglycerin?

Nitroglycerin is in a group of drugs called nitrates. Nitroglycerin dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump.

Nitroglycerin is used to treat or prevent attacks of chest pain (angina).

Nitroglycerin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about nitroglycerin?

Do not use nitroglycerin if you are taking sildenafil (Viagra). Serious, life-threatening side effects can occur if you take nitroglycerin while you are using sildenafil.

Nitroglycerin can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use nitroglycerin. Do not stop taking the medication. Ask your doctor before using any headache pain medication.

What should I discuss with my healthcare provider before taking nitroglycerin?

Do not use nitroglycerin if you are taking sildenafil (Viagra). Serious, life-threatening side effects can occur if you take nitroglycerin while you are using sildenafil. Do not use this medication if you are allergic to nitroglycerin, isosorbide mononitrate (Imdur), or isosorbide dinitrate (BiDil, Isordil), or if you have:
  • early signs of a heart attack (chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling);

  • severe anemia (a lack of red blood cells); or

  • a brain injury, hemorrhage, or tumor.

Before taking nitroglycerin, tell your doctor if you are allergic to any drugs, or if you have:

  • congestive heart failure;

  • a history of heart attack, stroke, or head injury;

  • low blood pressure;

  • glaucoma;

  • migraine headaches;

  • liver disease.

If you have any of these conditions, you may not be able to use nitroglycerin, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether nitroglycerin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Nitroglycerin can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use nitroglycerin. Do not stop taking the medication. Ask your doctor before using any headache pain medication.

How should I take nitroglycerin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

If possible, try to rest or stay seated when you use this medication. Nitroglycerin can cause dizziness or fainting.

If you use nitroglycerin sublingual spray to treat an angina attack: At the first sign of an attack, apply the spray directly on or under your tongue. Close your mouth after each spray. Do not inhale the spray. Do not shake the spray before or during use. You may use additional sprays every 5 minutes, but not more than 3 sprays in 15 minutes.

You may use nitroglycerin spray within 5 to 10 minutes before an activity you think might cause chest pain. Follow your doctor's instructions.

The nitroglycerin sublingual tablet should be placed under your tongue and allowed to dissolve slowly. Do not chew or swallow it.

The nitroglycerin buccal tablet should be placed between your cheek and gum and allowed to dissolve slowly. Do not chew or swallow it.

You may feel a slight burning or stinging in your mouth when you use this medication. However, this sensation is not a sign of how well the medication is working. Do not use more medication just because you do not feel a burning or stinging. Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time. Seek emergency medical attention if your chest pain gets worse or lasts more than 5 minutes, especially if you have trouble breathing or feel weak, dizzy, or nauseated, or lightheaded.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using nitroglycerin.

It is important to keep this medicine on hand at all times in case of an angina attack. Get your prescription refilled before you run out of medicine completely.

If you take nitroglycerin on a regular schedule to prevent angina, do not stop taking it suddenly or you could have a severe attack of angina. Store nitroglycerin tablets in the glass container at room temperature, away from moisture and heat. Keep the spray away from open flame or high heat, such as in a car on a hot day. The canister may explode if it gets too hot.

What happens if I miss a dose?

Since nitroglycerin is often used only as needed, you may not be on a dosing schedule. If you are using the medication regularly, use the missed dose as soon as you remember. If your next dose is less than 2 hours away, skip the missed dose and use the medicine at your next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of nitroglycerin can be fatal.

Symptoms of a nitroglycerin overdose may include a severe throbbing headache, confusion, fever, fast or pounding heartbeats, dizziness, vision problems, nausea, vomiting, bloody diarrhea, trouble breathing, cold or clammy skin, feeling light-headed, fainting, and seizures.

What should I avoid while taking nitroglycerin?

Nitroglycerin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase some of the side effects of nitroglycerin, such as dizziness, drowsiness, feeling light-headed, or fainting.

Nitroglycerin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using nitroglycerin and call your doctor at once if you have any of these serious side effects:
  • fast, slow, pounding, or uneven heart rate;

  • blurred vision or dry mouth;

  • feeling light-headed, nausea, vomiting, sweating, pale skin fainting; or

  • fever, sore throat, and headache with a severe blistering, peeling, and red skin rash.

Keep using nitroglycerin and talk to your doctor if you have any of these less serious side effects:

  • mild burning or tingling with the tablet in your mouth;

  • warmth, redness, or tingly feeling under your skin; or

  • feeling weak or dizzy.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect nitroglycerin?

Before taking nitroglycerin, tell your doctor if you are using any of the following drugs:

  • alteplase (Activase);

  • aspirin or heparin;

  • bladder or urinary medications such as oxybutynin (Ditropan) or tolterodine (Detrol);

  • blood pressure medication;

  • bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);

  • dihydroergotamine (D.H.E. 45, Migranal) or ergotamine (Ergomar, Cafergot, and others);

  • an erectile dysfunction medication such as tadalafil (Cialis) or vardenafil (Levitra);

  • antidepressants such as amitriptyline (Elavil, Etrafon), clomipramine (Anafranil), imipramine (Tofranil), and others;

  • a beta-blocker such as atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), and others;

  • a calcium channel blocker such as diltiazem (Tiazac, Cardizem), nifedipine (Procardia), nimodipine (Nimotop), verapamil (Calan, Covera, Verelan), and others;

  • irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, and others), or propantheline (Pro-Banthine);

  • any medication that causes dry mouth; or

  • medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), thioridazine (Mellaril), and others.

If you are using any of these drugs, you may not be able to use nitroglycerin, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect nitroglycerin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has information about nitroglycerin written for health professionals that you may read.

What does my medication look like?

Nitroglycerin is available with a prescription under many different brand and generic names. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 7.06. Revision Date: 2/2/07 1:28:31 PM.

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