Drug Profile

Pregnancy Warning

Nitroglycerin caused liver tumors in an animal carcinogenicity study and was positive in the Ames test (a test for DNA damage). It also caused death in rabbit pups whose mothers were treated with the drug. Use during pregnancy only for clear medical reasons. Tell your doctor if you are pregnant or thinking of becoming pregnant before you take this drug.

Breast-feeding Warning

There are no data from either human or animal studies. It is likely that this drug, like many others, is excreted in human milk. Because of the potential for serious adverse effects in nursing infants, it is advisable not to take this drug while nursing.

Heat Stress Alert

These drugs can affect your body’s ability to adjust to heat, putting you at risk of “heat stress.” If you live alone, ask a friend to check on you several times during the day. Early signs of heat stress are dizziness, lightheadedness, faintness, and slightly high temperature. Call your doctor if you have any of these signs. Drink more fluids (water, fruit and vegetable juices) than usual—even if you’re not thirsty—unless your doctor has told you otherwise. Do not drink alcohol.

Warning

If you are taking any member of the nitrate family of drugs, you should not take sildenafil (VIAGRA), vardenafil (LEVITRA), or tadalafil (CIALIS), which are drugs used for sexual dysfunction. The use of these erectile dysfunction drugs in men who were treated with a nitrate has resulted in deaths.

Tell your doctor if you have or have had:

• allergies to any adhesives, drugs, or other materials
• glaucoma
• hemorrhage of a blood vessel supplying the head
• food absorption problem
• recent heart attack or stroke or enlarged heart
• severe anemia
• trauma to the head
• kidney or liver problems
• overactive thyroid
• pregnancy or are breast-feeding

Tell your doctor about any other drugs you take, including aspirin, herbs, vitamins, and other nonprescription products.

• You may feel dizzy for a time, or faint, after taking these drugs, especially if you are upright and standing still. If you feel dizzy, put your head between your knees, breathe deeply, and move your arms and legs.
• You may develop a headache from the drug, but it can usually be relieved with aspirin.
• Be careful not to overexert yourself, even though your chest pain may feel better.
• Do not drink alcohol.
• If you are taking this drug regularly, do not stop taking it suddenly. Your doctor must give you a schedule to lower your dose gradually, to prevent chest pain and possible heart attack.
• Until you know how you react to this drug, do not drive or perform other activities requiring alertness.
• If applicable carry identification that you use nitroglycerin patches.
• If you seek emergency care, or have surgery, including dental, tell your doctor that you take nitroglycerin and the form you use.

For sublingual form:

• Place tablet under tongue and allow it to dissolve. Do not chew, crush, or swallow. While tablet is dissolving, do not eat, drink, or smoke.
• Store tablets only in the original container with the lid on tightly. Nitroglycerin is very sensitive and can lose strength rapidly if not stored properly. Do not add any other drug, material, or object to the container that was not there originally. Protect from air, heat, moisture, and sunlight. This includes times you carry nitroglycerin with you or store it away from home. Special stainless-steel containers are available to wear for emergency supplies of nitroglycerin. Once any container of nitroglycerin is opened, the supply should be replaced within six months.
• For isosorbide dinitrate and mononitrate: You should feel the drug’s effect in five minutes. If the pain does not go away in 5 to 10 minutes, take a second tablet. If you still have chest pain after three tablets in 15 minutes, call your doctor or go to an emergency room immediately.
• For nitroglycerin: You should feel the drug’s effect in 5 minutes. If the pain does not go away in 5 minutes, take a second tablet. If you still have chest pain after three tablets in 10 to 15 minutes, call your doctor or go to an emergency room immediately.
• Do not take other drugs without talking to your doctor first—especially nonprescription drugs for appetite control, asthma, colds, coughs, hay fever, or sinus problems. Alcohol use may cause low blood pressure.

For patch form:

• Open and prepare patch according to package instructions. Do not cut or trim the patch to adjust the dose.
• Select a site that is dry, on the chest, upper arm, or shoulders. Avoid areas that are broken, calloused, hairy, irritated, or shaved. Do not use sites below the knee or elbow, or areas where movement or clothing is apt to dislodge the patch. The need to rotate sites has recently been questioned.
• Press adhesive side of patch to skin firmly.
• Replace patch if it loosens or falls off.
• Leave on the amount of time specified by your doctor, then remove.
• Apply new patch at the same time each day.
• Discard used patch.
• Store unopened patches at room temperature. Do not expose to high temperatures or moisture. Do not store in a bathroom or refrigerator.

The following drugs, biologics (e.g., vaccines, therapeutic antibodies), or foods are listed in Evaluations of Drug Interactions 2003 as causing “highly clinically significant” or “clinically significant” interactions when used together with any of the drugs in this section. In some sections with multiple drugs, the interaction may have been reported for one but not all drugs in this section, but we include the interaction because the drugs in this section are similar to one another. We have also included potentially serious interactions listed in the drug’s FDA-approved professional package insert or in published medical journal articles. There may be other drugs, especially those in the families of drugs listed below, that also will react with this drug to cause severe adverse effects. Make sure to tell your doctor and pharmacist the drugs you are taking and tell them if you are taking any of these interacting drugs:

alteplase, CIALIS, D.H.E.-45, dihydroergotamine, ERGOMAR, ergotamine, heparin, imipramine, LEVITRA, sildenafil, tadalifil, TOFRANIL, vardenafil, VIAGRA.

The blood-pressure-lowering effects of drugs such as beta blockers, calcium channel blockers (long acting and short acting), traditional or "typical" antipsychotics, and antinausea drugs and prochlorperazine (COMPAZINE) and promethazine (PHENERGAN) are enhanced when taken with nitrates.

Call your doctor immediately if you experience:

• blurred vision
• dry mouth
• severe or prolonged headache
• skin rash

Call your doctor if these symptoms continue:

• dizziness, lightheadedness
• restlessness
• nausea or vomiting
• flushed face and neck
• rapid pulse or heartbeat
• burning, itching, or reddened skin

Signs of overdose:

• bluish lips, fingernails, or palms
• dizziness or fainting
• feeling of pressure in head
• shortness of breath
• unusual tiredness or weakness
• weak and unusually fast heartbeat
• fever
• seizures

If you suspect an overdose, call this number to contact your poison control center: (800) 222-1222.

Ask your doctor which of these tests should be done periodically while you are taking this drug:

• blood pressure and pulse
• heart function tests, such as electrocardiogram (ECG, EKG)