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Nitroglycerin

Nitroglycerin is a nitrate medication used primarily for the treatment of angina pectoris (chest pain due to coronary artery disease) and for managing heart failure. It works by dilating blood vessels, which improves blood flow and decreases the heart's workload, thereby alleviating angina symptoms.

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Frequently Asked Questions

How quickly does nitroglycerin work?
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Sublingual nitroglycerin usually starts to relieve angina within 1 to 5 minutes.

Can I take nitroglycerin with food?
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Sublingual tablets should be taken on an empty stomach for optimal absorption, but other forms may be taken with or without food.

What should I do if I miss a dose?
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For sublingual tablets, take the dose as soon as you remember during an angina attack. For chronic use, follow your healthcare provider's instructions regarding missed doses.

Are there any dietary restrictions while using nitroglycerin?
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There are no specific dietary restrictions while using nitroglycerin.

Is nitroglycerin safe during pregnancy or breastfeeding?
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Consult your healthcare provider if you are pregnant or breastfeeding to discuss the risks and benefits of using nitroglycerin in these situations

Comprehensive Drug Guide

How Does Nitroglycerin Work?

Nitroglycerin works by converting to nitric oxide in the body, which relaxes and dilates blood vessels (both veins and arteries). This vasodilation reduces the amount of blood returning to the heart (preload) and lowers the pressure in the arteries (afterload), leading to decreased oxygen demand by the heart and relief from angina.

Common Dosages

  • Sublingual Tablets: 0.3 mg, 0.6 mg.
  • Transdermal Patches: 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr, and 0.8 mg/hr.
  • Ointment: 2% nitroglycerin ointment.

Typical Dosing

  • For acute angina attacks: A sublingual tablet (0.3 mg to 0.6 mg) is taken at the onset of chest pain, and if symptoms persist, a second dose may be taken after 5 minutes; do not exceed 3 doses within 15 minutes.
  • For chronic angina: Transdermal patches may be applied once daily and worn for 12 to 14 hours, followed by a 10 to 12 hour patch-free interval.


Typical Dosing

FDA Approved Indications

  • Angina Pectoris: for the treatment and prevention of angina attacks.
  • Heart Failure: for the management of acute heart failure in some cases.
  • Acute Myocardial Infarction: for the treatment of heart attack.


Who Shouldn't Take Nitroglycerin?

  • Known hypersensitivity to nitroglycerin or other nitrates.
  • Severe anemia or hypotension.
  • Concurrent use of phosphodiesterase inhibitors (e.g., sildenafil) due to the risk of severe hypotension.


Advice From The Pharmacist

  • Use nitroglycerin exactly as prescribed and educate patients on proper administration techniques, especially for sublingual tablets.
  • Store nitroglycerin tablets in the original container and keep them tightly closed to maintain potency.
  • Monitor for side effects such as headache or dizziness, and report any severe reactions to a healthcare provider.


Side Effects of Nitroglycerin

Common Side Effects

  • Headache
  • Dizziness or lightheadedness
  • Flushing
  • Nausea
  • Rapid heartbeat


Uncommon/Severe Side Effects

  • Severe hypotension (low blood pressure)
  • Fainting
  • Allergic reactions (rash, itching, swelling).


Risks and Warnings of Nitroglycerin

  • Hypotension: Monitor blood pressure closely, especially when initiating treatment or adjusting doses.
  • Tolerance: Prolonged use may lead to tolerance; a patch-free interval is recommended to minimize this risk.


Interactions with Nitroglycerin

Common Drug Interactions

  • Phosphodiesterase Inhibitors: Combining nitroglycerin with medications like sildenafil can cause severe hypotension.
  • Other Antihypertensives: Caution is advised when using other medications that lower blood pressure.


Alternatives to Nitroglycerin

  • Other Nitrates: Such as isosorbide dinitrate or isosorbide mononitrate for angina management.
  • Calcium Channel Blockers: For angina and hypertension.