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Nitroglycerin Medication: Uses, Dosage, and Side Effects Explained
Summary of Key Points
Nitroglycerin is a commonly prescribed heart medication used to manage chest pain (angina), heart failure, and other cardiovascular conditions. It works by relaxing blood vessels, which improves blood flow and reduces the heart’s workload. Nitroglycerin is available in several forms, including tablets, sprays, and patches. Always consult your healthcare provider before starting or adjusting your dosage. Our telemedicine providers are available to assist with managing your treatment.
Names of Nitroglycerin Medication
US Brand Names: Nitrostat, Nitrolingual, Nitro-Dur, Minitran, Rectiv
Generic Name: Nitroglycerin
The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. In this article, the generic name is listed in parentheses.
Pharmacologic Category of Nitroglycerin
Vasodilators
Nitrates
Nitroglycerin Dosage and Administration Instructions
Nitroglycerin is used to treat a variety of heart and vascular conditions. The appropriate dosage depends on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. Our telemedicine providers are available to help adjust your treatment plan if needed.
Nitroglycerin for Angina Pectoris (Chest Pain)
Acute Relief: 0.3 to 0.6 mg sublingually (under the tongue) every 5 minutes as needed, up to 3 doses within 15 minutes. If pain persists, seek medical attention immediately.
Prevention of Angina: 2.5 to 9 mg orally, 2 to 4 times daily.
Nitroglycerin for Heart Failure
Acute Heart Failure: 5 to 10 mcg/min IV infusion, titrated to effect. The dose may be increased as necessary.
Nitroglycerin for Myocardial Infarction (Heart Attack)
Acute Treatment: 5 to 10 mcg/min IV infusion, titrated to effect. The dose may be increased as necessary.
Nitroglycerin for Hypertension (High Blood Pressure)
Acute Hypertension: 5 to 100 mcg/min IV infusion, titrated to effect.
Nitroglycerin for Coronary Artery Disease
Chronic Management: 2.5 to 9 mg orally, 2 to 4 times daily.
Nitroglycerin for Pulmonary Hypertension (Off-label Use)
Off-label Use: Consult your healthcare provider for specific dosing recommendations.
Nitroglycerin for Esophageal Spasm (Off-label Use)
Off-label Use: 0.3 to 0.6 mg sublingually as needed for acute symptom relief.
Nitroglycerin for Acute Coronary Syndrome
Acute Treatment: 5 to 10 mcg/min IV infusion, titrated to effect.
Nitroglycerin for Cardiac Ischemia
Acute Treatment: 5 to 10 mcg/min IV infusion, titrated to effect.
Nitroglycerin for Aortic Stenosis (Off-label Use)
Off-label Use: Consult your healthcare provider for specific dosing recommendations.
Dosage Forms and Strengths of Nitroglycerin
Sublingual Tablets: 0.3 mg, 0.4 mg, 0.6 mg
Transdermal Patches: 0.1 mg/hour, 0.2 mg/hour, 0.4 mg/hour, 0.6 mg/hour, 0.8 mg/hour
Oral Capsules (Extended Release): 2.5 mg, 6.5 mg, 9 mg
Translingual Spray: 0.4 mg per spray
Rectal Ointment: 0.4% (Rectiv)
Contraindications for Nitroglycerin Use
A contraindication is a specific situation where a medication should not be used because it may cause harm. Nitroglycerin has several contraindications, meaning there are conditions or medications that make it unsafe. Below is a list of situations where Nitroglycerin should not be taken:
- Severe Anemia: Nitroglycerin can lower blood pressure, which may worsen symptoms in individuals with severe anemia, a condition where there are not enough red blood cells to carry oxygen.
- Increased Intracranial Pressure: Nitroglycerin can raise pressure in the brain, which is dangerous for people with head injuries or other conditions that cause elevated intracranial pressure.
- Allergy to Nitroglycerin: If you have a known allergy to Nitroglycerin or any of its components, taking it could trigger a serious allergic reaction, including difficulty breathing or swelling.
- Use of Phosphodiesterase Inhibitors (e.g., Sildenafil [Viagra], Tadalafil [Cialis]): These medications, used to treat erectile dysfunction and pulmonary hypertension, can cause a dangerous drop in blood pressure when combined with Nitroglycerin.
- Hypotension (Low Blood Pressure): Nitroglycerin lowers blood pressure, so if you already have low blood pressure, it could drop to dangerously low levels.
- Severe Aortic Stenosis: In this condition, the heart struggles to pump blood through a narrowed aortic valve. Nitroglycerin can reduce blood flow, worsening symptoms.
Drug-to-Drug Interactions with Nitroglycerin
Certain medications can interact with Nitroglycerin, potentially leading to harmful effects. It is important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below is a list of medications that may interact with Nitroglycerin:
- Sildenafil (Viagra): Taking Sildenafil with Nitroglycerin can cause a severe drop in blood pressure.
- Tadalafil (Cialis): Like Sildenafil, Tadalafil can dangerously lower blood pressure when combined with Nitroglycerin.
- Vardenafil (Levitra): Another erectile dysfunction medication that should not be taken with Nitroglycerin due to the risk of low blood pressure.
- Riociguat (Adempas): Used to treat pulmonary hypertension, this medication can also cause a dangerous drop in blood pressure when taken with Nitroglycerin.
- Ergotamine (Ergomar): Used to treat migraines, Ergotamine can increase the risk of side effects when taken with Nitroglycerin.
Nitroglycerin in Pregnancy
Is it safe to take Nitroglycerin during pregnancy? The safety of Nitroglycerin use during pregnancy has not been fully established. Classified as a Category C drug by the FDA, Nitroglycerin has shown some risks in animal studies, but there are no well-controlled studies in pregnant women. If you are pregnant or planning to become pregnant, it’s essential to discuss the potential risks and benefits of Nitroglycerin with your healthcare provider. They can help you carefully weigh the possible risks to your baby against the benefits of managing your heart condition.
Nitroglycerin While Breastfeeding
Is it safe to take Nitroglycerin while breastfeeding? Limited information is available on whether Nitroglycerin passes into breast milk. Due to the potential for adverse effects on a nursing infant, it’s important to consult your healthcare provider if you are breastfeeding. They may recommend alternative treatments or advise you to monitor your baby closely for any signs of side effects.
Estimated Cost of Nitroglycerin Medication
The cost of Nitroglycerin can vary depending on the form (tablet, spray, patch) and dosage. Without insurance, a 30-day supply of Nitroglycerin sublingual tablets typically costs between $10 and $20 with a GoodRx coupon. Prices may differ based on the pharmacy and location, so it’s a good idea to check GoodRx or other discount programs to find the best price.
Possible Alternatives to Nitroglycerin
If Nitroglycerin is not suitable for you, there are alternative treatments and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss these options in more detail.
Angina Pectoris
Alternatives include beta-blockers (e.g., Metoprolol), calcium channel blockers (e.g., Amlodipine), and lifestyle changes such as quitting smoking and reducing stress.
Heart Failure
Common alternatives include ACE inhibitors (e.g., Lisinopril), ARBs (e.g., Losartan), and diuretics (e.g., Furosemide). Lifestyle changes, such as reducing salt intake and engaging in regular exercise, can also be beneficial.
Myocardial Infarction (Heart Attack)
Aspirin, beta-blockers, and statins (e.g., Atorvastatin) are typical alternatives. In addition, adopting a heart-healthy diet and maintaining regular physical activity are important lifestyle changes.
Hypertension (High Blood Pressure)
ACE inhibitors, ARBs, and calcium channel blockers are often prescribed. Reducing sodium intake and maintaining a healthy weight can also help manage blood pressure effectively.
Coronary Artery Disease
Statins, aspirin, and beta-blockers are common treatments. A heart-healthy diet, regular exercise, and quitting smoking are essential lifestyle modifications.
Pulmonary Hypertension
Medications such as Sildenafil (Revatio) or Bosentan (Tracleer) may be used. Oxygen therapy and lifestyle changes, such as avoiding high altitudes, can also help manage symptoms.
Esophageal Spasm
Calcium channel blockers and proton pump inhibitors (e.g., Omeprazole) may be alternatives. Dietary changes, such as avoiding spicy foods, can also provide relief.
Acute Coronary Syndrome
Aspirin, beta-blockers, and statins are commonly used. Immediate medical intervention is crucial, so always seek emergency care if you experience symptoms.
Cardiac Ischemia
Beta-blockers, calcium channel blockers, and statins are often prescribed. Lifestyle changes, such as quitting smoking and managing stress, are also important for managing this condition.
Aortic Stenosis
In severe cases, surgery may be required. Medications like beta-blockers can help manage symptoms, but lifestyle changes, such as avoiding strenuous activity, are also recommended.
Recent Updates on Nitroglycerin Research
Recent research on Nitroglycerin has explored its potential benefits beyond heart conditions. Some studies are investigating its use in treating chronic anal fissures and aiding wound healing due to its ability to improve blood flow. However, these uses are still under investigation, and more research is needed to confirm their effectiveness. If you’re interested in learning more about these potential new applications, speak with your healthcare provider. You can also schedule a telemedicine appointment with one of our providers to discuss the latest research and how it may apply to your treatment plan.
