Dosing & Uses
Dosage Forms & Strengths
tablet, SL
- 0.3mg
- 0.4mg
- 0.6mg
powder, SL (GoNitro)
- 0.4mg
Angina Pectoris (Acute Relief)
0.3-0.6 mg SL q5min up to 3 times; use at first sign of angina
Prompt medical attention needed if no relief
Dissolve under tongue or in buccal pouch; do not rinse mouth or spit for 5 minutes after administration
Angina Pectoris (Prophylaxis)
1 tablet SL 5-10 minutes before activities likely to provoke angina attacks
Renal Failure
CrCl: 10-50 mg/min: Administer q24-72hr for prophylaxis
CrCl <10 mL/min: Administer q72-96hr for prophylaxis
Not FDA approved
Angina Pectoris (Acute Relief)
0.3-0.6 mg SL q5min up to 3 times; use at first sign of angina
Prompt medical attention needed if no relief
Dissolve under tongue or in buccal pouch; do not rinse mouth or spit for 5 minutes after adminstration
Angina Pectoris (Prevention)
1 tablet SL 5-10 minutes before activities likely to provoke angina attacks
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (12)
- avanafil
nitroglycerin sublingual, avanafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.
- bromocriptine
bromocriptine decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.
- cabergoline
cabergoline decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.
- dihydroergotamine
dihydroergotamine decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.
- dihydroergotamine intranasal
dihydroergotamine intranasal decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.
- ergoloid mesylates
ergoloid mesylates decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.
- ergotamine
ergotamine decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.
- methylergonovine
methylergonovine decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.
- riociguat
nitroglycerin sublingual, 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 sublingual, sildenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.
- tadalafil
nitroglycerin sublingual, tadalafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.
- vardenafil
nitroglycerin sublingual, vardenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.
Serious - Use Alternative (5)
- cabergoline
nitroglycerin sublingual increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.
- ergoloid mesylates
nitroglycerin sublingual increases effects of ergoloid mesylates by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.
- ergotamine
nitroglycerin sublingual increases effects of ergotamine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.
- lofexidine
lofexidine, nitroglycerin sublingual. 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 sublingual increases effects of methylergonovine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.
Monitor Closely (14)
- amlodipine
amlodipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
- arginine
nitroglycerin sublingual, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.
- aspirin
aspirin increases effects of nitroglycerin sublingual by additive vasodilation. Use Caution/Monitor. Vasodilatory and hemodynamic effects of NTG may be enhanced by coadministration with aspirin (additive effect desirable for emergent treatment).
- bretylium
nitroglycerin sublingual, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.
- bupivacaine implant
nitroglycerin sublingual, 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.
- clevidipine
clevidipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
- felodipine
felodipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
- isradipine
isradipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
- nicardipine
nicardipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
- nifedipine
nifedipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
- nimodipine
nimodipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
- nisoldipine
nisoldipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
- tetracaine
tetracaine, nitroglycerin sublingual. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- verapamil
verapamil, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.
Minor (3)
- acetylcysteine
acetylcysteine increases effects of nitroglycerin sublingual by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.
- acetylcysteine (Antidote)
acetylcysteine (Antidote) increases effects of nitroglycerin sublingual by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.
- ethanol
nitroglycerin sublingual, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.
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
Early myocardial infarction, severe anemia, increased intracranial pressure, and known hypersensitivity to nitroglycerin
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
Riociguat; coadministration may cause hypotension
Narrow angle glaucoma (controversial: may not be clinically significant)
Acute circulatory failure or shock
Cautions
Caution in MI or CHF, alcohol use, increased ICP (eg, head trauma, cerebral hemorrhage; potential contraindication), hyperthyroidism, hypertrophic cardiomyopathy, increased IOP, postural hypotension, volume depletion, low systolic BP
Severe hypotension, particularly with upright posture, may occur with small doses of nitroglycerin particularly in patients with constrictive pericarditis, aortic or mitral stenosis, patients who may be volume- depleted; symptoms of severe hypotension (nausea, vomiting, weakness, pallor, perspiration and collapse/syncope) may occur even with therapeutic doses
Inability to relieve chest pain after 3 doses indicates acute MI-rush to ER if possible
Lack of burning/tingling does not indicate loss of potency
Store in original container at room temp; protect from moisture
Discard unused tabs 6 months after bottle opened
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
Benefits of sublingual nitroglycerin in patients with acute myocardial infarction or congestive heart failure not established; if one elects to use nitroglycerin in these conditions, careful clinical or hemodynamic monitoring must be used because of possibility of hypotension and tachycardia
Use smallest dose required for effective relief acute anginal attack; excessive use may lead to development of tolerance
Sublingual tablets should not be swallowed
Hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris
May aggravate angina caused by hypertrophic cardiomyopathy
Industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance rarely 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
Discontinue drug if blurring of vision or drying of mouth occurs; excessive dosage of nitroglycerin may produce severe headaches
Nitroglycerin produces dose-related headaches, especially at start of nitroglycerin therapy, which may be severe and persist but usually subside with continued use
Pregnancy & Lactation
Pregnancy
Limited published data on use of nitroglycerin are insufficient to determine 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 nitroglycerin is present in human milk or if nitroglycerin has effects on milk production
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
Half-Life: 1-4 min
Onset: 1-3 min (antianginal and hemodynamic effects)
Duration of antianginal effects: Up to 30 min
Duration of hemodynamic effects: Up to 30 min
Bioavailability: 38.5%
Protein bound: 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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Nitro-Bid transdermal - | 2 % ointment |  | |
| Nitro-Time oral - | 9 mg capsule |  | |
| Nitro-Time oral - | 6.5 mg capsule |  | |
| Nitro-Time oral - | 2.5 mg capsule |  | |
| 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 - | 0.6 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 - | 0.6 mg tablet |  | |
| nitroglycerin sublingual - | 0.3 mg tablet |  | |
| nitroglycerin sublingual - | 0.6 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 - | 0.3 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 intravenous - | 50 mg/10 mL (5 mg/mL) vial |  | |
| 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 |  | |
| Nitro-Dur transdermal - | 0.3 mg/hr transdermal system |  | |
| Nitrolingual translingual - | 400 mcg/spray solution |  | |
| Rectiv rectal - | 0.4 % (w/w) ointment |  | |
| Nitromist translingual - | 400 mcg/spray aerosol |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
nitroglycerin sublingual
NITROGLYCERIN POWDER PACKET - SUBLINGUAL
(NYE-troe-GLIS-er-in)
COMMON BRAND NAME(S): Gonitro
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).Carefully read the Instructions for Use 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.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).Sit down before using this medication. Holding the packet upright and as close to your mouth as possible, tear open the packet and pour all of the powder under your tongue. Close your mouth right away and breathe normally through your nose. Let all of the powder dissolve before you swallow. Do not rinse your mouth or spit for 5 minutes after taking a dose.The dosage is based on your medical condition and response to treatment. A dose of this medication may be either 1 or 2 packets. Follow your doctor's instructions about how many packets you should take for each dose. After you take your first dose of nitroglycerin powder, you may take 1 more packet every 5 minutes, if needed. Do not take more than 3 packets of nitroglycerin powder within 15 minutes.If you are using this medication to prevent chest pain before physical activities, use it 5 to 10 minutes before the activity.If this medication is used very often, it may not work as well. Talk with your doctor if this medication stops working well.
SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, flushing, and burning/tingling under the tongue 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, 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 are: 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, vericiguat.This medication may interfere with certain lab tests (such as blood cholesterol levels), possibly causing false test results. Make sure lab 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 and moisture. 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 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
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