nitroglycerin translingual (Rx)

Brand and Other Names:Nitrolingual, glyceryl trinitrate translingual spray, more...NitroMist
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

spray

  • 0.4mg/spray

Angina

1-2 spray(s) PRN for angina, may repeat q3-5min, not to exceed 3 sprays in 15 minutes

Spray onto or under tongue; do not inhale, expectorate or rinse mouth for 5-10 minutes

Seek medical attention if pain persists after 3 doses in 15 minutes

Angina, Prophylaxis

1-2 sprays 5-10 minutes before activities likely to cause angina

Renal Failure

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

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

Not approved

Angina

Angina1-2 spray(s) PRN for angina, may repeat q3-5min, not to exceed 3 sprays in 15 minutes

Spray onto or under tongue; do not inhale, expectorate or rinse mouth for 5-10 minutes

Seek medical attention if pain persists after 3 doses in 15 minutes

Angina, prophylaxis

1-2 sprays 5-10 minutes before activities likely to cause angina

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Interactions

Interaction Checker

and nitroglycerin translingual

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (12)

            • avanafil

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

            • bromocriptine

              bromocriptine decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.

            • cabergoline

              cabergoline decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.

            • dihydroergotamine

              dihydroergotamine decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.

            • ergoloid mesylates

              ergoloid mesylates decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.

            • ergotamine

              ergotamine decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.

            • methylergonovine

              methylergonovine decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.

            • riociguat

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

            • tadalafil

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

            • vardenafil

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

            Serious - Use Alternative (5)

            • cabergoline

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

            • ergoloid mesylates

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

            • ergotamine

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

            • lofexidine

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

            Monitor Closely (5)

            • arginine

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

            • bretylium

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

            • bupivacaine implant

              nitroglycerin translingual, 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.

            • dapsone topical

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

            • tetracaine

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

            Minor (3)

            • acetylcysteine

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

            • acetylcysteine (Antidote)

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

            • ethanol

              nitroglycerin translingual, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

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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

            Hypersensitivity

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            Warnings

            Contraindications

            Hypersensitivity

            AMI, 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

            Soluble guanylate cyclase (sGC) stimulator, riociguat; coadministration may cause hypotension

            Narrow angle glaucoma (controversial: may not be clinically significant)

            Increased intracranial pressure

            Circulatory failure or shock

            Cautions

            CHF, alcohol use, glaucoma, hyperthyroidism, hypertrophic cardiomyopathy, increased ICP (eg, head trauma, cerebral hemorrhage; potential contraindication), increased IOP, postural hypotension, volume depletion, low systolic BP

            Severe hypotension may occur with small doses especially in patients with constrictive pericarditis, aortic or mitral stenosis, volume depleted patients or that are already hypotensive; hypotension may be accompanied by paradoxical bradycardia and/or increased angina pectoris

            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; excessive use my lead to development of tolerance

            Inability to relieve chest pain after 3 doses may mean AMI-rush to ER if possible

            Discontinue if blurred vision develops

            Prime pump prior to first use or after prolonged nonuse

            Use supportive treatment in overdose

            May aggravate the angina caused by hypertrophic obstructive cardiomyopathy

            Nitroglycerin produces dose-related headaches, especially at the start of nitroglycerin therapy, which may be severe and persistent but usually subside with continued use

            Dose selection for elderly should start at low end of dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy

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            Pregnancy & Lactation

            Pregnancy

            Limited published data on the use of nitroglycerin are insufficient to determine a drug-associated risk of major birth defects or miscarriage; in animal reproduction studies, there were no adverse developmental effects when nitroglycerin was administered intravenously to rabbits or intraperitoneally to rats during organogenesis at doses greater than 64-times the human dose

            Lactation

            Sublingual nitroglycerin has not been studied in lactating women; not known if drug is present in human milk, or if nitroglycerin has effects on milk production or the breastfed child; therefore, the developmental and health benefits of breastfeeding should be considered along with the mother’s need for nitroglycerin and any potential adverse effects on breastfed child from nitroglycerin or from underlying maternal condition

            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 & converted to nitric oxide (NO) leading to production 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

            Half-Life: 1-4 min

            Onset: 2 min

            Duration: Up to 1 hr

            Protein Bound: 11-60%

            Vd: 3 L/kg

            Metabolism: Mainly in 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
            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
            -
            0.4 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
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 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
            -
            0.4 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
            Nitrostat sublingual
            -
            0.4 mg tablet
            Nitrostat sublingual
            -
            0.6 mg tablet
            Nitrostat sublingual
            -
            0.4 mg tablet
            Nitrostat sublingual
            -
            0.3 mg tablet
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Dur transdermal
            -
            0.3 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
            -
            0.6 mg/hr transdermal system
            Nitro-Dur transdermal
            -
            0.3 mg/hr transdermal system
            GoNitro sublingual
            -
            400 mcg powder
            GoNitro sublingual
            -
            400 mcg powder
            nitroglycerin intravenous
            -
            50 mg/10 mL (5 mg/mL) vial
            Rectiv rectal
            -
            0.4 % (w/w) ointment
            Nitro-Time oral
            -
            9 mg capsule
            Nitro-Time oral
            -
            6.5 mg capsule
            Nitro-Time oral
            -
            2.5 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
            nitroglycerin oral
            -
            6.5 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
            nitroglycerin oral
            -
            2.5 mg capsule
            nitroglycerin oral
            -
            2.5 mg capsule
            Nitromist translingual
            -
            400 mcg/spray aerosol
            Nitrolingual translingual
            -
            400 mcg/spray solution
            Nitrolingual translingual
            -
            400 mcg/spray solution
            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
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

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            Patient Education
            nitroglycerin transdermal

            NITROGLYCERIN OINTMENT - TRANSDERMAL

            (NYE-troe-GLIS-er-in)

            COMMON BRAND NAME(S): Nitro-Bid

            USES: Nitroglycerin ointment is used to prevent chest pain (angina) in people with a certain heart condition (coronary artery disease). This medication 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.This medication will not relieve chest pain once it occurs. It is also not intended to be used just before physical activities (such as exercise, sexual activity) to prevent chest pain. Other medications may be needed in these situations. Consult your doctor for more details.

            HOW TO USE: Read the Patient Information Leaflet available from your pharmacist. Consult your doctor or pharmacist if you have any questions.Apply this medication as directed by your doctor. Avoid touching the ointment with your fingers. Carefully squeeze out your dose onto a paper dose-measuring applicator. These applicators are supplied with the medication. Place the paper applicator with the ointment side down onto a dry, hairless area of skin, usually on the chest. Do not rub the ointment into the skin. Using the paper, lightly spread the ointment to cover an area of a size directed by your doctor. Tape the paper applicator into place and cover with plastic wrap to avoid staining your clothing. Wash your hands after applying and removing the medication.Remember to use a different area for each application. It is important to apply this medication at the same times each day. Do not change the dosing times unless directed by your doctor. The dosage is based on your medical condition and response to treatment. Remove the medication daily as directed by your doctor.Use this medication regularly to get the most benefit from it. Do not stop using this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.Although unlikely, when this medication is used for a long time, it may not work as well and may require different dosing. Tell your doctor if this medication stops working well (for example, you have worsening chest pain or it occurs more often).

            SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, and flushing may occur. If any of these effects last or get worse, 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 you have any serious side effects, including: fainting, fast/irregular/pounding heartbeat.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 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: 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: slow heartbeat, vision changes, severe nausea/vomiting, sweating, cold/clammy skin, bluish fingers/toes/lips.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as blood pressure monitoring) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Lifestyle changes such as dietary changes, exercise, and stopping smoking may help this drug work better. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.

            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 away from light and moisture. Close the tube tightly right after each use. Do not store in the bathroom. 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 April 2022. Copyright(c) 2022 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

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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            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.