nitroglycerin PO (Rx)

Brand and Other Names:glyceryl trinitrate PO
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule, extended release

  • 2.5mg
  • 6.5mg
  • 9mg

Angina Pectoris (Prophylaxis)

ER capsule: Initial 2.5-6.5 mg PO q6-8hr

Titrate up to effect dose until limited by SE

Renal Failure

CrCl: 10-50 mg/min: Administer q24-72hr

CrCl<10 mL/min: Administer q72-96hr

Not FDA approved

Angina Pectoris (Prophylaxis)

ER capsule: Initial 2.5-6.5 mg PO q6-8hrTitrate up to effec dose until limited by SE

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Interactions

Interaction Checker

and nitroglycerin PO

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        Significant - Monitor Closely

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            Contraindicated (5)

            • avanafil

              nitroglycerin PO, avanafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • riociguat

              nitroglycerin PO, riociguat. Either increases effects of the other by additive vasodilation. Contraindicated. Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension.

            • sildenafil

              nitroglycerin PO, sildenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • tadalafil

              nitroglycerin PO, tadalafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • vardenafil

              nitroglycerin PO, vardenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            Serious - Use Alternative (5)

            • cabergoline

              nitroglycerin PO increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • ergoloid mesylates

              nitroglycerin PO increases effects of ergoloid mesylates by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • ergotamine

              nitroglycerin PO increases effects of ergotamine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • lofexidine

              lofexidine, nitroglycerin PO. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • methylergonovine

              nitroglycerin PO increases effects of methylergonovine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            Monitor Closely (8)

            • arginine

              nitroglycerin PO, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

            • benazepril

              nitroglycerin PO, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. monitor blood pressure.

            • bretylium

              nitroglycerin PO, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • bupivacaine implant

              nitroglycerin PO, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

            • captopril

              nitroglycerin PO, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • dapsone topical

              nitroglycerin PO increases toxicity of dapsone topical by altering metabolism. Modify Therapy/Monitor Closely. May induce methemoglobinemia.

            • maraviroc

              maraviroc, nitroglycerin PO. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

            • tetracaine

              tetracaine, nitroglycerin PO. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

            Minor (2)

            • acetylcysteine

              acetylcysteine increases effects of nitroglycerin PO by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

            • acetylcysteine (Antidote)

              acetylcysteine (Antidote) increases effects of nitroglycerin PO by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

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            Adverse Effects

            Common

            Headache

            Hypotension

            Tachycardia

            Dizziness

            Lightheadedness

            Blurred vision

            Flushing

            N/V

            Nervousness

            Xerostomia

            Serious

            Methemoglobinemia (rare)

            Syncope

            Prolonged bleeding time

            Exfoliative dermatitis

            Unstable angina

            Rebound hypertension

            Thrombocytopenia

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            Warnings

            Contraindications

            Hypersensitivity, acute MI, severe anemia

            Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life

            Coadministration with soluble guanylate cyclase stimulators, including riociguat

            Cautions

            Use caution in increased ICP (eg, head trauma, cerebral hemorrhage; potential contraindication), hyperthyroidism, increased IOP, postural hypotension, volume depletion, low systolic BP

            Do not change brands unintentionally as not all are bioequivalent

            Treat drug-induced headache with aspirin or acetaminophen

            Provide nitrate-free interval (10-12 hr or overnight) to avoid development of tolerance

            Angina long term prophylaxis, NOT for acute relief

            Lack of burning/tingling does not indicate loss of potency

            Discontinue if blurred vision occurs

            Use supportive treatment in overdose

            Benefits of oral nitroglycerin in patients with acute myocardial infarction or congestive heart failure not established; if administered in these conditions, use careful clinical or hemodynamic monitoring to avoid hazards of hypotension and tachycardia; because effects of capsules are so difficult to terminate rapidly, not recommended in these settings

            Severe hypotension, particularly with upright posture, may occur with even small doses; should be used with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive; hypotension induced by therapy may be accompanied by paradoxical bradycardia and increased angina pectoris

            Therapy may aggravate angina caused by hypertrophic cardiomyopathy

            As tolerance to other forms of nitroglycerin develops, effect of sublingual nitroglycerin on exercise tolerance, although still observable, is somewhat blunted

            In industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance clearly occurs; chest pain, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates from these workers, demonstrating existence of true physical dependence

            Some clinical trials in angina patients have provided nitroglycerin for about 12 continuous hours of every 24-hour day; during nitrate-free intervals in some of these trials, anginal attacks have been more easily provoked than before treatment, and patients have demonstrated hemodynamic rebound and decreased exercise tolerance; importance of these observations not known

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known whether the drug crosses into breast milk, use caution

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Organic nitrate which causes systemic venodilation, decreasing preload

            Cellular mechanism: nitrate enters vascular smooth muscle and converted to nitric oxide (NO) leading to activation of cGMP & vasodilation

            Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial O2 demand

            Also improves coronary collateral circulation. Lower BP, increase HR, occasional paradoxical bradycardia

            Pharmacokinetics

            onset: within 1- hr4

            Duration antianginal effects: Up to 12 hr

            Bioavailability: 38.5%

            Protein Bound: 11-60%

            Vd: 3 L/kg

            Metabolism: Liver, extrahepatic sites: vascular wall, RBC

            Metabolites: 1,3-glyceryl dinitrate, 1,2-glyceryl dinitrate, & glyceryl mononitrate (inactive)

            Clearance: 5.5-11 L/min

            Excretion: urine

            Dialyzable: No

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Bid transdermal
            -
            2 % ointment
            nitroglycerin intravenous
            -
            50 mg/10 mL (5 mg/mL) vial
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.3 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.3 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            Nitrostat sublingual
            -
            0.4 mg tablet
            Nitrostat sublingual
            -
            0.6 mg tablet
            Nitrostat sublingual
            -
            0.4 mg tablet
            Nitrostat sublingual
            -
            0.3 mg tablet
            Minitran transdermal
            -
            0.6 mg/hr transdermal system
            Minitran transdermal
            -
            0.4 mg/hr transdermal system
            Minitran transdermal
            -
            0.1 mg/hr transdermal system
            Minitran transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.1 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.1 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.3 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.6 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.2 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.8 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.3 mg/hr transdermal system
            Nitromist translingual
            -
            400 mcg/spray aerosol
            nitroglycerin oral
            -
            6.5 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
            nitroglycerin oral
            -
            2.5 mg capsule
            nitroglycerin oral
            -
            2.5 mg capsule
            Nitro-Time oral
            -
            9 mg capsule
            Nitro-Time oral
            -
            6.5 mg capsule
            Nitro-Time oral
            -
            2.5 mg capsule
            Rectiv rectal
            -
            0.4 % (w/w) ointment
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            GoNitro sublingual
            -
            400 mcg powder
            GoNitro sublingual
            -
            400 mcg powder
            Nitrolingual translingual
            -
            400 mcg/spray solution
            Nitrolingual translingual
            -
            400 mcg/spray solution

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

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            Patient Education
            nitroglycerin sublingual

            NITROGLYCERIN - SUBLINGUAL

            (NYE-troe-GLIS-er-in)

            COMMON BRAND NAME(S): Nitrostat

            USES: This medication is used to relieve chest pain (angina) in people that have a certain heart condition (coronary artery disease). It may also be used before physical activities (such as exercise, sexual activity) to help prevent chest pain.Nitroglycerin belongs to a class of drugs known as nitrates. Angina occurs when the heart muscle is not getting enough blood. This drug works by relaxing and widening blood vessels so blood can flow more easily to the heart.

            HOW TO USE: Ask your doctor now for exact instructions on how to use your nitroglycerin and when to call for emergency medical help (911).Read the Patient Information Leaflet if available from your pharmacist before you start using nitroglycerin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Sit down before using this medication. Place 1 tablet under the tongue and allow it to dissolve as directed by your doctor. Do not chew or swallow the tablet. The dosage is based on your medical condition and response to treatment.If you are using this medication to prevent chest pain before physical activities, use it 5 to 10 minutes before the activity.If you are using this medication to relieve chest pain once it occurs, use it as soon as possible. If your chest pain has not improved or if it has worsened 5 minutes after you use this drug, call emergency medical help (911). After calling the emergency number, use another dose. Five minutes after the second dose, if you still have chest pain and the ambulance has not arrived, use a third dose. If your chest pain is not gone after 15 minutes and 3 doses of nitroglycerin, call emergency medical help (911) if you have not called already. Do not use more than 3 doses during an attack unless directed by your doctor.

            SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, flushing, and burning/tingling under the tongue may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Headache is often a sign that this medication is working. Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). If the headaches continue or become severe, tell your doctor promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if these unlikely but serious side effects occur: fainting, fast/irregular/pounding heartbeat.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using this medication, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as isosorbide mononitrate); or to nitrites; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: recent head injury, anemia, low blood pressure, dehydration, other heart problems (such as recent heart attack).This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this medication, especially dizziness and lightheadedness which could increase the risk of falls.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk or if it may harm a nursing infant. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: drugs used to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), certain drugs to treat migraine headaches (ergot alkaloids such as ergotamine), riociguat.This medication may interfere with certain laboratory tests (including blood cholesterol levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow heartbeat, vision changes, severe nausea/vomiting, sweating, cold/clammy skin, bluish fingers/toes/lips.

            NOTES: Do not share this medication with others.

            MISSED DOSE: Not applicable.

            STORAGE: Store at room temperature away from light, heat, and moisture. Do not store in the bathroom. Keep in the original glass bottle with the cap tightly closed. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.