$Unique_ID{BRK03254} $Pretitle{} $Title{nitroglycerin (systemic)} $Subject{Nitro-Bid Plateau Caps Marion Nitrocine Timecaps Schwarz Pharma Pharma Nitrogard Parke-Davis Nitroglycerin Lilly Nitroglyn Key Nitrolingual Rorer Wharton Nitrong Nitrostat Antianginal systemic angina chest pain vasodilator relaxes muscles blood vessels oxygen prevent relieve} $Volume{} $Log{} Copyright (C) 1993 Publications International, Ltd. nitroglycerin (systemic) ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) Nitro-Bid Plateau Caps (Marion) Nitrocine Timecaps (Schwarz Pharma) Nitrogard (Parke-Davis) Nitroglycerin (Lilly) Nitroglyn (Key) Nitrolingual (Rorer) Nitrong (Wharton) Nitrostat (Parke-Davis) TYPE OF DRUG Antianginal INGREDIENT nitroglycerin DOSAGE FORMS Sustained-release tablets (2.6 mg, 6.5 mg, and 9 mg) Sustained-release capsules (2.5 mg, 6.5 mg, and 9 mg) Sublingual tablets (0.15 mg, 0.3 mg, 0.4 mg, and 0.6 mg) Buccal tablets, controlled release (1 mg, 2 mg, and 3 mg) Oral spray (6.4 mg per dose) STORAGE Nitroglycerin tablets, capsules, and oral spray should be stored in a tightly capped bottle in a cool, dry place. The sublingual tablets should be kept in their original glass container. A small, temporary supply of tablets can also be stored in a stainless-steel container that is now available. The pendant-type container, which can be worn around your neck, is a convenient storage place for an emergency supply. NEVER store them in the refrigerator or the bathroom medicine cabinet, because the drug may lose its potency. USES This medication is used to treat angina (chest pain). Nitroglycerin is a vasodilator, which relaxes the muscles of the blood vessels, causing an increase in the oxygen supply to the heart. The oral tablets and capsules do not act quickly; they are used to prevent chest pain. The sublingual tablets and oral spray act quickly and can be used to relieve chest pain after it has started. TREATMENT You should take the sustained-release tablets or capsules with a full glass of water on an empty stomach one hour before or two hours after a meal. The tablets and capsules should be swallowed whole. Chewing, crushing, or breaking them destroys their sustained-release activity and possibly increases the side effects. NEVER chew or swallow the sublingual or buccal tablets. The sublingual tablet and oral spray forms of the drug are absorbed directly through the lining of the mouth. The sublingual tablet should be allowed to dissolve under the tongue or against the cheek. To use the spray, remove the plastic cover on the container. Then, without shaking the container, spray the medication onto or under the tongue. Try not to inhale the spray. Close your mouth after each spray, and try to avoid swallowing right away. Nitroglycerin spray loses its effectiveness if it is swallowed. Take one tablet or one or two spray doses at the first sign of chest pain. Sit down while you are waiting for the medicine to take effect. Do not eat, drink, or smoke while nitroglycerin is in your mouth. Try not to swallow while nitroglycerin is dissolving, and do not rinse your mouth afterward. Sublingual nitroglycerin or nitroglycerin spray should start working in one to three minutes. If there is no relief, take another tablet in five minutes. IF YOU TAKE THREE TABLETS OR THREE SPRAY DOSES WITHOUT ANY SIGN OF IMPROVEMENT, CALL A DOCTOR IMMEDIATELY OR GO TO A HOSPITAL EMERGENCY ROOM. As a preventive measure, take a nitroglycerin sublingual tablet or a spray dose five or ten minutes before heavy exercise, exposure to high altitudes or extreme cold, or any other potentially stressful situation. Be sure to carry some nitroglycerin sublingual tablets or oral spray with you at ALL times. The buccal tablet should be placed between the upper lip and the gum on either side of the front teeth or between the cheek and the gum. The tablet is held in place by a sticky gel seal that develops once the tablet is in contact with saliva. If you wear dentures, the tablet can be placed anywhere between the cheek and the gum. Avoid drinking hot liquids or touching the tablet with your tongue. This can cause the tablet to dissolve faster and could increase the risk of side effects. If the tablet is swallowed by mistake, replace it with another tablet. Nitroglycerin buccal tablets lose their effectiveness when swallowed. Try not to take the buccal tablet at bedtime in order to avoid inadvertently swallowing and choking on the tablet while you are sleeping. If you miss a dose of the sustained-release tablets or capsules, take the missed dose as soon as possible, unless it is more than halfway through the interval between doses. In that case, do not take the missed dose at all; just return to your regular dosing schedule. Do not double the next dose. SIDE EFFECTS Minor. Dizziness, flushing of the face, headache, light-headedness, nausea, vomiting, or weakness. These side effects should disappear as your body adjusts to the medication. If you feel dizzy or light-headed, sit or lie down for a while; get up slowly from a sitting or reclining position, and be careful on stairs. To avoid dizziness or light-headedness when you stand, contract and relax the muscles of your legs for a few moments before rising. Do this by pushing one foot against the floor while raising the other foot slightly, alternating feet so that you are "pumping" your legs in a pedaling motion. Acetaminophen may help to relieve headaches. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about diarrhea, fainting, palpitations, rash, or sweating. INTERACTIONS Nitroglycerin can interact with other types of medications: 1. The combination of alcohol and nitroglycerin can lead to dizziness and fainting. 2. Nitroglycerin can increase the side effects of the tricyclic antidepressants. Before starting to take nitroglycerin, BE SURE TO TELL YOUR DOCTOR about any medications you are currently taking, especially tricyclic antidepressants. WARNINGS * Tell your doctor about unusual or allergic reactions you have had to any medications, especially to nitroglycerin or isosorbide dinitrate. * Before starting to take this medication, be sure to tell your doctor if you now have or if you have ever had anemia, glaucoma, a head injury, low blood pressure, or thyroid disease or if you have recently had a heart attack. * If this drug makes you dizzy or light-headed, do not take part in any activity that requires alertness, such as driving a car or operating potentially dangerous machinery. * Before surgery or other medical or dental treatment, tell your doctor or dentist you are taking this drug. * Tolerance may develop to this medication within one to three months. If it seems to lose its effectiveness, contact your doctor. * You should not discontinue use of nitroglycerin (if you have been taking it on a regular basis) unless you first consult your doctor. Stopping the drug abruptly may lead to further chest pain. Your doctor may, therefore, want to decrease your dosage gradually. * If you have frequent diarrhea, you may not be absorbing the sustained-release form of this medication. Discuss this with your doctor. * While taking this medication, do not take any over-the-counter (nonprescription) asthma, allergy, sinus, cough, cold, or diet preparations unless you first check with your doctor or pharmacist. Some of these drugs decrease the effectiveness of nitroglycerin. * The cotton plug should be removed when the bottle is first opened; it should NOT be replaced (the cotton absorbs some of the medication, decreasing its potency). * Nitroglycerin is highly flammable. Do not use it in places where it might be ignited. * Be sure to tell your doctor if you are pregnant. Although the systemic form of nitroglycerin appears to be safe, extensive studies in pregnant women have not been conducted. Also, tell your doctor if you are breast-feeding an infant. It is not known whether nitroglycerin passes into breast milk. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.