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Nitroglycerin Ointment: Uses, Dosage, and Application Tips
Summary or Key Points
Nitroglycerin ointment is a medication commonly prescribed to manage various heart conditions, such as angina, heart failure, and high blood pressure. It works by relaxing blood vessels, which improves blood flow and reduces the heart’s workload. Additionally, it is used to treat conditions like anal fissures and Raynaud’s phenomenon. Always follow your healthcare provider’s instructions when using this medication. If you have any questions, our telemedicine providers are available to assist you.
Names of Medication
US Brand Name: Nitro-Bid (Nitroglycerin)
The generic name refers to the active ingredient in the medication, listed in parentheses. This is the non-branded name of the drug.
Pharmacologic Category
Vasodilator
Nitrate
Nitroglycerin Ointment Dosage
Nitroglycerin ointment is used to treat a variety of conditions, with the dosage depending on the specific condition being treated. Always consult your doctor before making any changes to your dose. Our telemedicine providers are available to help with any questions or concerns.
Angina Pectoris (Chest Pain)
Initial dose: Apply 1/2 inch of nitroglycerin ointment to the chest or back every 6-8 hours.
Maintenance dose: The dose may be increased to 1 inch every 6-8 hours, depending on your response to the treatment.
Length of treatment: As directed by your healthcare provider.
Heart Failure
Initial dose: Apply 1/2 inch of nitroglycerin ointment to the chest or back every 6-8 hours.
Maintenance dose: The dose may be increased to 1 inch every 6-8 hours, depending on your response.
Length of treatment: As directed by your healthcare provider.
Myocardial Infarction (Heart Attack)
Initial dose: Apply 1/2 inch of nitroglycerin ointment to the chest or back every 6-8 hours.
Maintenance dose: The dose may be increased to 1 inch every 6-8 hours, depending on your response.
Length of treatment: As directed by your healthcare provider.
Coronary Artery Disease
Initial dose: Apply 1/2 inch of nitroglycerin ointment to the chest or back every 6-8 hours.
Maintenance dose: The dose may be increased to 1 inch every 6-8 hours, depending on your response.
Length of treatment: As directed by your healthcare provider.
Hypertension (High Blood Pressure)
Initial dose: Apply 1/2 inch of nitroglycerin ointment to the chest or back every 6-8 hours.
Maintenance dose: The dose may be increased to 1 inch every 6-8 hours, depending on your response.
Length of treatment: As directed by your healthcare provider.
Peripheral Artery Disease
Initial dose: Apply 1/2 inch of nitroglycerin ointment to the affected area every 6-8 hours.
Maintenance dose: The dose may be increased to 1 inch every 6-8 hours, depending on your response.
Length of treatment: As directed by your healthcare provider.
Anal Fissures
Initial dose: Apply a pea-sized amount (approximately 1/4 inch) of nitroglycerin ointment to the anal area every 12 hours.
Length of treatment: Typically 3-6 weeks, or as directed by your healthcare provider.
Esophageal Spasm
Initial dose: Apply 1/2 inch of nitroglycerin ointment to the chest or back every 6-8 hours.
Maintenance dose: The dose may be increased to 1 inch every 6-8 hours, depending on your response.
Length of treatment: As directed by your healthcare provider.
Raynaud’s Phenomenon
Initial dose: Apply 1/4 inch of nitroglycerin ointment to the affected fingers or toes every 6-8 hours.
Length of treatment: As directed by your healthcare provider.
Pulmonary Hypertension
Initial dose: Apply 1/2 inch of nitroglycerin ointment to the chest or back every 6-8 hours.
Maintenance dose: The dose may be increased to 1 inch every 6-8 hours, depending on your response.
Length of treatment: As directed by your healthcare provider.
Dosage Forms and Strengths
Ointment: 2% (available in 30g and 60g tubes)
How to Apply Nitroglycerin Ointment
Nitroglycerin ointment should be applied to clean, dry skin. It is typically applied to the chest, back, or the affected area, depending on the condition being treated. Use the applicator provided to measure the correct amount. Do not rub the ointment into the skin; instead, spread it gently. Be sure to wash your hands after applying the ointment. Avoid contact with your eyes or mouth.
Contraindications for Nitroglycerin Ointment
A contraindication is a specific situation where a medication should not be used because it may cause harm. There are several contraindications for nitroglycerin ointment.
Severe Anemia: Nitroglycerin can lower blood pressure and reduce oxygen delivery to tissues, which may worsen symptoms in individuals with severe anemia.
Increased Intracranial Pressure: Nitroglycerin can raise pressure inside the brain, posing risks for individuals with head injuries or elevated intracranial pressure.
Allergy to Nitroglycerin or Nitrates: If you are allergic to nitroglycerin or other nitrates, using this ointment may trigger a severe allergic reaction, including rash, difficulty breathing, or swelling.
Use of PDE-5 Inhibitors (e.g., Sildenafil, Tadalafil): These medications, often prescribed for erectile dysfunction, can dangerously lower blood pressure when combined with nitroglycerin.
Severe Hypotension (Low Blood Pressure): Nitroglycerin can further lower blood pressure, potentially leading to fainting, dizziness, or shock in individuals with already low blood pressure.
Drug to Drug Interactions with Nitroglycerin Ointment
It’s important to be aware of medications that may interact with Nitroglycerin ointment. These interactions can either increase the risk of side effects or reduce the effectiveness of your treatment. Always inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements.
Sildenafil (Viagra): Using this medication with Nitroglycerin can cause a dangerous drop in blood pressure.
Tadalafil (Cialis): Similar to Sildenafil, combining this drug with Nitroglycerin can result in a severe drop in blood pressure.
Vardenafil (Levitra): Another PDE-5 inhibitor that can lead to dangerously low blood pressure when used with Nitroglycerin.
Riociguat (Adempas): This medication, used to treat pulmonary hypertension, can also interact with Nitroglycerin, leading to dangerously low blood pressure.
Ergotamine (Cafergot): Used to treat migraines, this drug can reduce the effectiveness of Nitroglycerin and increase the risk of side effects.
Nitroglycerin Ointment in Pregnancy
Is it safe to use Nitroglycerin ointment during pregnancy?
There is limited data on the safety of Nitroglycerin ointment during pregnancy. The FDA classifies it as a Category C medication, meaning animal studies have shown some risk, but there are no well-controlled studies in pregnant women. Nitroglycerin should only be used if the potential benefits outweigh the risks. If you are pregnant or planning to become pregnant, it’s essential to discuss this with your healthcare provider before using Nitroglycerin ointment. Our telemedicine providers are available to help you make an informed decision.
Nitroglycerin Ointment while Breastfeeding
Is it safe to use Nitroglycerin ointment while breastfeeding?
There is limited information on whether Nitroglycerin passes into breast milk. Due to the potential for serious side effects in nursing infants, caution is advised when using Nitroglycerin ointment while breastfeeding. Consult your healthcare provider to carefully weigh the risks and benefits. If you are breastfeeding and considering Nitroglycerin ointment, our telemedicine providers can guide you through your options.
Estimated Cost of Nitroglycerin Ointment
The estimated cost of a 30-day supply of Nitroglycerin ointment without insurance, using a GoodRx coupon, ranges from $20 to $40. Prices may vary depending on the pharmacy and location. Be sure to check GoodRx or other discount services for the most up-to-date pricing.
Possible Alternatives to Nitroglycerin Ointment
Depending on your condition, alternative treatments or lifestyle changes may help manage your symptoms. Always discuss these options with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these alternatives.
- Angina Pectoris: Alternatives include beta-blockers (e.g., Metoprolol), calcium channel blockers (e.g., Amlodipine), or lifestyle changes such as quitting smoking, reducing stress, and improving diet and exercise.
- Heart Failure: ACE inhibitors (e.g., Lisinopril), diuretics (e.g., Furosemide), and lifestyle changes like reducing salt intake and monitoring fluid levels may be considered.
- Myocardial Infarction (Heart Attack): Aspirin, beta-blockers, and statins (e.g., Atorvastatin) are commonly used. Lifestyle changes such as a heart-healthy diet and regular exercise are also important.
- Coronary Artery Disease: Statins, antiplatelet drugs (e.g., Clopidogrel), and lifestyle changes like weight management and smoking cessation may help.
- Hypertension (High Blood Pressure): ACE inhibitors, calcium channel blockers, and lifestyle changes such as reducing sodium intake, exercising regularly, and managing stress can be effective.
- Peripheral Artery Disease: Antiplatelet medications, statins, and lifestyle changes like quitting smoking and increasing physical activity are often recommended.
- Anal Fissures: Topical calcium channel blockers (e.g., Diltiazem) or botulinum toxin injections may be alternatives. Increasing fiber intake and staying hydrated can also help.
- Esophageal Spasm: Calcium channel blockers or proton pump inhibitors (e.g., Omeprazole) may be used. Avoiding trigger foods and practicing stress management techniques can also help.
- Raynaud’s Phenomenon: Calcium channel blockers or vasodilators (e.g., Nifedipine) may be used. Keeping hands and feet warm and avoiding smoking can reduce symptoms.
- Pulmonary Hypertension: Medications like endothelin receptor antagonists (e.g., Bosentan) or phosphodiesterase-5 inhibitors (e.g., Sildenafil) may be alternatives. Regular exercise and oxygen therapy may also help.
Recent Updates on Nitroglycerin Ointment Research
Recent studies have explored the expanded use of Nitroglycerin ointment for conditions beyond traditional cardiovascular applications. For example, ongoing research into its effectiveness in treating chronic anal fissures has shown promising results, with improved healing rates. Additionally, studies are investigating its potential role in managing Raynaud’s phenomenon and esophageal spasms, though more research is needed to confirm these benefits. As always, consult your healthcare provider before considering new treatments. Our telemedicine providers are available to discuss the latest research and how it may apply to your condition.
