Nitroglycerin Topical

Nitroglycerin topical is used for long-term prevention of chest pain (angina pectoris) and to treat congestive heart failure.

Nitroglycerin topical is available under the following different brand and other names: Nitrol, Nitro Bid, NitroBid Topical, glyceryl trinitrate topical, and Topical Nitroglycerin.

Dosage Forms and Strengths

Ointment

• 2%

Dosage Considerations – Should be Given as Follows:

Angina Pectoris (Long-Term Prophylaxis)

• 0.5-2 inches applied in am and 6 hours later to truncal skin

Congestive Heart Failure

• 1.5 inches, increase by 0.5-1 inch up to 4 inches, every 4 hours

Safety and efficacy not established in pediatric patients.

Common side effects of Nitroglycerin Topical include:

• Headache
• Low blood pressure (hypotension)
• Fast heart rate
• Dizziness
• Lightheadedness
• Blurred vision
• Flushing
• Nausea
• Vomiting
• Nervousness
• Dry mouth
• Topical allergic reactions

Serious side effects of nitroglycerin topical include:

• Methemoglobinemia (rare)
• Lightheadedness and fainting
• Prolonged bleeding time
• Exfoliative dermatitis
• Unstable angina
• Rebound high blood pressure (hypertension)
• Low blood platelets (thrombocytopenia)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, 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.

• Severe interactions of nitroglycerin topical include:
  • avanafil
  • bromocriptine
  • cabergoline
  • dihydroergotamine
  • dihydroergotamine intranasal
  • ergoloid mesylates
  • ergotamine
  • methylergonovine
  • sildenafil
  • tadalafil
  • vardenafil
• Serious interactions of nitroglycerin topical include:
  • cabergoline
  • ergoloid mesylates
  • ergotamine
  • lofexidine
  • methylergonovine
• Moderate interactions of nitroglycerin topical include:
  • arginine
  • bretylium
  • tetracaine
• Mild interactions of nitroglycerin topical include:
  • acetylcysteine
  • acetylcysteine (antidote)
  • ethanol

Warnings

This medication contains nitroglycerin topical. Do not take Nitrol, Nitro Bid, NitroBid Topical, glyceryl trinitrate topical, or Topical Nitroglycerin if you are allergic to nitroglycerin topical or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity to organic nitrates
• 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 low blood pressure (hypotension)
• Narrow angle glaucoma (controversial: may not be clinically significant)
• Severe anemia

Effects of Drug Abuse

• No information available.

Short-Term Effects

• See "What Are Side Effects Associated with Using Nitroglycerin Topical?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Nitroglycerin Topical?"

Cautions

• Alcohol use, increased intracranial pressure (head trauma, cerebral hemorrhage-potential contraindication), hyperthyroidism, hypertrophic cardiomyopathy, increased intraocular pressure, hypotension, volume
• depletion, low systolic blood pressure
• Do not change brands unintentionally as not all are bioequivalent
• Treat drug-induced headache with aspirin or acetaminophen
• Provide nitrate-free interval (10-12 hours or overnight) to avoid development of tolerance
• Discontinue if blurred vision develops
• Do not apply with fingers; do not rub or massage
• Use supportive treatment in overdose

Pregnancy and Lactation

Use nitroglycerin topical with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.

It is not known whether nitroglycerin topical crosses into breast milk. Use caution while breastfeeding.