Nitroglycerin

About Nitroglycerin

Nitroglycerin relaxes veins and arteries, which lowers the heart’s workload and eases the chest pain of angina from coronary artery disease. The sublingual tablet and spray act within minutes and are used to stop an attack or, 5 to 10 minutes beforehand, to prevent one brought on by exertion. The patch releases the drug steadily through the skin to prevent attacks; its label says it acts too slowly to stop one.

The tablet and spray labels give the same routine for an attack. Sit down, then dissolve one tablet under the tongue or in the cheek, or use one or two sprays onto or under the tongue, at the first sign of pain. If the pain is not relieved, one more dose may be taken about every 5 minutes, to a total of three in 15 minutes. If the pain persists after three doses, or feels different from usual, the label calls for prompt medical attention, and MedlinePlus says your doctor may tell you to call for emergency help as soon as the first dose does not help much, and to call if the pain has not gone 5 minutes after the third dose. Ask your prescriber which rule applies to you.

Headache, dizziness, flushing and lightheadedness on standing are the common effects, and alcohol makes them worse. The labels rule out sildenafil, tadalafil, vardenafil and avanafil, used for erections and pulmonary hypertension, and riociguat, because with a nitrate they can drop blood pressure dangerously. It is also not used in severe anemia or raised pressure inside the skull. No form has a boxed warning.

The patch is worn for 12 to 14 hours a day and left off for 10 to 12 hours, usually overnight, because the drug stops working if the body is never free of it, and a defibrillator paddle must not be discharged over a patch. Rectiv is a different product: nitroglycerin ointment at 0.4 percent, applied inside the anal canal every 12 hours for up to three weeks for moderate to severe pain from a chronic anal fissure; headache is very common with it. The FDA records the Rectiv brand as discontinued, and an AB-rated generic from Cosette, approved in 2024, is the product now dispensed.

Taking Nitroglycerin

How to take it

Tablets: sit down and let one dissolve under the tongue or in the cheek, repeating every 5 minutes if needed, up to three. Spray: prime a new bottle before first use, hold it upright, spray onto or under the tongue without inhaling, and do not rinse your mouth for 5 to 10 minutes. Patch: a new site of clean, hairless skin on the upper body or upper arm each day, worn for 12 to 14 hours. Ointment: one inch inside the anus every 12 hours with a covered finger; wash your hands afterward.

If you miss a dose

Tablets and spray are used only when needed. Patch: apply it as soon as you remember, unless it is nearly time for the next one; then skip it. Ointment: apply it when you remember unless the next dose is near. Do not double up.

Storage

Tablets stay in the original glass bottle, tightly capped after every use, at room temperature; do not move them to another container. Keep the spray away from heat and flames. Keep patches at room temperature, not refrigerated, and fold used ones sticky sides together before discarding. Throw away the ointment eight weeks after opening.

Interactions to know about

Sildenafil, tadalafil, vardenafil and avanafil must not be taken with any form, and the tablet, spray and patch labels also rule out riociguat. Alcohol and other blood pressure medicines add to dizziness and fainting. Get up slowly, and tell the prescriber about headaches that do not settle.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Nitroglycerin differs from pharmacy to pharmacy

Sublingual tablets and sprays are small prescriptions, often used only a few times, so the dispensing fee is most of the quote and pharmacies set it very differently. The tablets lose potency once exposed to air, so a smaller bottle can be better value than a larger one that will be thrown away. Sprays cost pharmacies more than tablets.

Patches are a daily maintenance product with several generic makers, quoted by the box, with prices that differ by strength and maker. The rectal ointment has few generic makers and one tube is a full course, so the quote depends on whether the pharmacy stocks it.

Ways to pay less for Nitroglycerin without insurance

• Ask the prescriber whether tablets or the spray suit you better; tablets usually cost less.
• Ask the pharmacy to quote the bottle sizes it stocks; a larger bottle is not better value if it expires unused.
• For patches, ask for a ninety-day supply at the settled strength, and compare quotes between makers.
• For the rectal ointment, make sure the prescription allows generic substitution and check that the pharmacy has it in stock.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Nitroglycerin

1. 1.Exactly what should I do during an attack, and when should I call emergency services?
2. 2.Do I take any erection or pulmonary hypertension medicines that must not be combined with it?
3. 3.How should I store the tablets and spray, and when should I replace them?
4. 4.When should I put the patch on and take it off, and where?
5. 5.What can I take for the headaches?

Related medications