Nitroglycerin Sublingual

Nitroglycerin Sublingual is a prescription medication used in the treatment or prophylaxis of acute Angina Pectoris. 

• Nitroglycerin Sublingual is available under the following different brand names: Nitrostat, Nitrolingual Pumpspray, GoNitro, NitroQuick, Glyceryl Trinitrate Sublingual, Sublingual Nitroglycerin

Adult dosage

Tablet, SL

• 0.3mg
• 0.4mg
• 0.6mg

Powder, SL (GoNitro)

• 0.4mg

Angina Pectoris (Acute Relief)

Adult dosage

• 0.3-0.6 mg SL every 5 minutes up to 3 times; use at the first sign of angina
• Prompt medical attention is needed if no relief
• Dissolve under the tongue or in the buccal pouch; do not rinse mouth or spit for 5 minutes after administration

Angina Pectoris (Prophylaxis)

Adult dosage

• 1 tablet SL 5-10 minutes before activities likely to provoke angina attacks

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Nitroglycerin Sublingual include:

• flushing (sudden warmth, redness, or tingly feeling), 
• lightheadedness, 
• fainting, 
• headache, 
• dizziness, 
• numbness,
• blurred vision,
• tingling, and 
• burning pain

Serious side effects of Nitroglycerin Sublingual include:

• hives, 
• sweating, 
• pale skin, 
• nausea, 
• vomiting, 
• weakness, 
• lightheadedness, 
• difficulty breathing,
• swelling of the face, lips, tongue, or throat, 
• severe or throbbing headaches that do not become less severe with continued use of nitroglycerin, 
• pounding heartbeats, 
• fluttering in the chest, 
• slow heart rate, 
• blurred vision, 
• dry mouth, 
• chest pain or pressure, 
• pain spreading to the jaw or shoulder, 
• nausea, and
• sweating

Rare side effects of Nitroglycerin Sublingual include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Nitroglycerin Sublingual has severe interactions with at least 12 other drugs. 
• Nitroglycerin Sublingual has serious interactions with the following drugs:
  • cabergoline
  • ergoloid mesylates
  • ergotamine
  • lofexidine 
  • methylergonovine
• Nitroglycerin Sublingual has moderate interactions with at least 14 other drugs. 
• Nitroglycerin Sublingual has minor interactions with the following drugs:
  • acetylcysteine
  • acetylcysteine (Antidote)
  • ethanol

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Early myocardial infarction, severe anemia, increased intracranial pressure, and known hypersensitivity to nitroglycerin
• Recent use (within several days) of PDE-5 inhibitors (e.g., 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

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Nitroglycerin Sublingual?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Nitroglycerin Sublingual?”

Cautions

• Caution in MI or CHF, alcohol use, increased ICP (e.g., 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 indicate acute MI-rush to ER if possible
• Lack of burning/tingling does not indicate loss of potency
• Store in the 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 intervals (10-12 hours or overnight) to avoid the 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 the possibility of hypotension and tachycardia
• Use the smallest dose required for effective relief of acute anginal attack; excessive use may lead to the 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 the 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 the start of nitroglycerin therapy, which may be severe and persist but usually subside with continued use

Pregnancy and Lactation

• 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 nitroglycerin is present in human milk or if nitroglycerin has effects on milk production