Nitroglycerin Transmucosal

Nitroglycerin transmucosal is used for acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease.

Nitroglycerin transmucosal is available under the following different brand names: Nitrogard and Nitromist.

Dosages of Nitroglycerin Transmucosal:

• Lingual aerosol, 400 mcg per spray, 230 metered sprays per container
• Tablet, 2.6 mg

Dosage Considerations – Should be Given as Follows:

• At the onset of an attack, one or two metered sprays should be administered on or under the tongue. A spray may be repeated approximately every 5 minutes as needed.
• A maximum of 3 metered sprays is recommended within a 15-minute period. If chest pain persists after a total of 3 sprays, prompt medical attention is recommended.
• It may be used prophylactically 5 to 10 minutes before engaging in activities that might precipitate an acute attack

Side effects of nitroglycerin transmucosal include:

• Headache
• Flushing
• Low blood pressure (hypotension)
• Lightheadedness/fainting

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.

Drug interactions of nitroglycerin transmucosal include:

• PDE5 inhibitors
• Antihypertensives
• Aspirin
• Tissue-type plasminogen activator (tPA)
• Heparin
• Ergotamine

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products 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.

Warnings
 

This medication contains nitroglycerin transmucosal. Do not take Nitrogard or Nitromist if you are allergic to nitroglycerin transmucosal 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

• Use of a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5 inhibitors), such as sildenafil, vardenafil, and tadalafil 
• Severe anemia
• Increased intracranial pressure
• History of hypersensitivity to NitroMist or other nitrates or nitrites

Effects of Drug Abuse

• No information available

Short-Term Effects

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

Long-Term Effects

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

Cautions

• Excessive use may lead to the development of tolerance. Only the smallest number of doses required for effective relief of the acute anginal attack should be used. As tolerance to other forms of nitroglycerin develops, the effect of sublingual nitroglycerin on exercise tolerance, although still observable, is reduced.
• Severe hypotension, particularly with upright posture, may occur even with small doses of nitroglycerin. Therefore, the drug should be used with caution in patients who may be volume-depleted or who, for whatever reason, are already hypotensive. Hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris. The benefits of NitroMist in patients with acute myocardial infarction or congestive heart failure have not been established. If one elects to use NitroMist in these conditions, careful clinical or hemodynamic monitoring must be used because of the possibility of hypotension and tachycardia.
• Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy.
• Nitroglycerin produces dose-related headaches, which may be severe. Tolerance to headaches occurs.

Pregnancy and Lactation

There are no adequate and well-controlled studies of nitroglycerin transmucosal in pregnant women. Nitroglycerin transmucosal should be given to a pregnant woman only if clearly needed.

It is unknown if nitroglycerin transmucosal is excreted in human milk. Because many drugs are excreted in human milk, use when taking nitroglycerin transmucosal while breastfeeding.