Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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.
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
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
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.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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Rectiv rectal - | 0.4 % (w/w) ointment |  | |
| Nitro-Dur transdermal - | 0.3 mg/hr transdermal system |  | |
| nitroglycerin intravenous - | 50 mg/10 mL (5 mg/mL) vial |  | |
| Nitro-Time oral - | 9 mg capsule |  | |
| Nitro-Time oral - | 6.5 mg capsule |  | |
| Nitro-Time oral - | 2.5 mg capsule |  | |
| nitroglycerin transdermal - | 0.6 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.4 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 - | 0.6 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.4 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.2 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.4 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.6 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 |  | |
| nitroglycerin transdermal - | 0.2 mg/hr transdermal system |  | |
| nitroglycerin transdermal - | 0.1 mg/hr transdermal system |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.3 mg tablet |  | |
| nitroglycerin sublingual - | 0.6 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 |  | |
| nitroglycerin sublingual - | 0.4 mg tablet |  | |
| nitroglycerin sublingual - | 0.4 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 | | |
| nitroglycerin oral - | 2.5 mg capsule | | |
| nitroglycerin oral - | 9 mg capsule | | |
| nitroglycerin oral - | 6.5 mg capsule | | |
| nitroglycerin translingual - | 400 mcg/spray solution |  | |
| nitroglycerin translingual - | 400 mcg/spray solution |  | |
| nitroglycerin translingual - | 400 mcg/spray solution |  | |
| nitroglycerin translingual - | 400 mcg/spray solution |  | |
| Nitromist translingual - | 400 mcg/spray aerosol |  | |
| 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.
Patient Handout
nitroglycerin rectal
NITROGLYCERIN OINTMENT - RECTAL
(NYE-troe-GLIS-er-in)
COMMON BRAND NAME(S): Rectiv
USES: Nitroglycerin ointment is used to treat moderate to severe pain caused by long-term tears in the lining of the anus (anal fissures). This medication works by relaxing the muscles around the blood vessels which reduces pressure inside the anus and relieves pain. Nitroglycerin belongs to a class of drugs known as nitrates.
HOW TO USE: 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.Cover your finger with plastic wrap, a disposable medical glove, or a finger cot. Using the measuring guide that comes with your product, squeeze out the prescribed amount of ointment onto your finger. Gently insert your finger inside the anus, up to the first finger joint. Spread the ointment around the inside of the anus. If you cannot do this because it is too painful, you may apply the ointment to the outside of the anus.Throw away the finger covering and wash your hands after each dose. Apply this medication usually every 12 hours, for up to 3 weeks, or as directed by your doctor. Do not apply this medication in the eyes, mouth, or vagina.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day.Tell your doctor if your pain does not improve.
SIDE EFFECTS: Headache may occur, but usually lasts a short time after each dose. With continued use of this medication, some people may not be bothered as much by the headaches. Your doctor may recommend treating headaches with a nonprescription pain reliever (such as acetaminophen).Nitroglycerin can also cause a drop in your blood pressure, which can lead to dizziness and lightheadedness. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.If any of these effects last or get worse, tell your doctor or pharmacist promptly.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.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: 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 nitroglycerin; or to nitrates, nitrites, or isosorbide; 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: anemia, low blood pressure, dehydration, increased pressure inside your head (such as due to head/brain injury), heart/blood vessel problems (such as heart failure, 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 because they can also cause a drop in your blood pressure. 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.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. 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 to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), riociguat, vericiguat.
OVERDOSE: This medicine may be harmful if swallowed. 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: pale/gray/blue colored skin/lips/nails, severe headache, fainting, shortness of breath, fast heartbeat, confusion, unusual tiredness.
NOTES: Do not share this medication with others.
MISSED DOSE: If you miss a dose, apply it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature and keep the tube tightly closed. Discard the tube within 8 weeks of opening. 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 for more details.
Information last revised October 2022. Copyright(c) 2023 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.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
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