Using Nitroglycerin for Angina
What is nitroglycerin?
Nitroglycerin is a
vasodilator, a medicine that opens blood vessels to improve blood flow. It is
used to treat
angina, a type of chest pain or discomfort that happens when there
is not enough blood flowing to the heart. To improve blood flow to the heart,
nitroglycerin opens up (dilates) the arteries in the heart (coronary arteries), which improves symptoms and
reduces how hard the heart has to work.
Nitroglycerin comes in
quick-acting forms and long-acting forms.
Quick-acting forms of
nitroglycerin are used to relieve angina or used just before
activities that typically cause angina. The quick-acting forms include
tablets or oral sprays. The tablets are placed under the tongue (sublingual) or
between the cheek and gum (buccal). The spray is used on or under the tongue.
This topic covers these quick-acting forms of nitroglycerin.
Long-acting forms of nitroglycerin are used to prevent angina from
happening. They are not used to stop sudden symptoms of angina. These long-acting forms
include pills, tablets, skin ointment, and skin patches. This topic does
not cover these long-acting forms of
Your doctor will prescribe the right amount for you.
Do not use another person's nitroglycerin.
When do I use quick-acting nitroglycerin?
doctor will advise you when to use your nitroglycerin. In general, quick-acting
nitroglycerin is used:
- To relieve sudden angina.
stressful activities that can cause angina, such as walking uphill or having
How do I use quick-acting nitroglycerin?
- Sit or lie down to take your nitroglycerin.
If you are driving, pull over and park the car. Taking nitroglycerin can lower
your blood pressure, which could cause you to pass out if you are standing up.
- For sudden episodes of angina, use nitroglycerin in a tablet or
liquid spray form.
- Place the under-the-tongue (sublingual)
tablet under your tongue. Leave it there until it dissolves. If you
accidentally swallow the tablet, take another. The medicine won't work if it is
- Place the between-cheek-and-gum (buccal) tablet between
your cheek and gum. Leave it there until it dissolves. If you accidentally
swallow the tablet, take another. The medicine won't work if it is
- Use the spray under your tongue or on top of your
tongue. Push the spray canister button once. Close your mouth right
- Take one tablet or spray dose. If after 5
minutes the chest pain is not better or gets worse, call 911 or other emergency services immediately.
- After you call
911 , continue to stay on the phone with
the emergency operator. He or she will give you further
- Regardless of what happens, you should let your
doctor know that you had an episode of angina. If this is unusual for you, if your
angina episodes are occurring more frequently or lasting longer, or if you need
more medicine to control them, tell your doctor. Report any change in your
chest pain (unstable angina) to your doctor.
Are there side effects or interactions with other drugs that I should be aware of?
Normal, temporary side effects of
nitroglycerin include a warm or flushed feeling, headache, dizziness, or
lightheadedness. You may also feel a burning sensation under your
Do not take the erection-enhancing medicine sildenafil
(Viagra), vardenafil (Levitra), and tadalafil (Cialis) if you are taking
nitroglycerin. Combining nitroglycerin with any of these medicines can cause a
life-threatening drop in blood pressure. If you develop chest pain and have
taken one of these erection-enhancing medicines, be sure to tell your doctor so
that you are not given nitroglycerin or another nitrate medicine.
Do not take the
pulmonary hypertension medicine sildenafil (Revatio)
if you are taking nitroglycerin or another nitrate medicine.
How should I store nitroglycerin?
nitroglycerin pills in a dark-colored (such as brown), airtight, glass
container that you cannot see through. Keep the container tightly closed. Keep
nitroglycerin pills and liquid spray away from heat or moisture.
Can nitroglycerin get old and lose potency?
Nitroglycerin can get old. And when it is old, it may not work. If your
nitroglycerin supply is past its expiration date, get a new prescription as
soon as possible. Keep your nitroglycerin in the container it came in and
tightly closed. Do not open your sublingual nitroglycerin until you need a
dose. Replace your tablets every 3 to 6 months. A nitroglycerin spray may last
up to 2 years before it expires.
You may get a headache when you
use nitroglycerin. Or you may feel burning or tingling under your tongue with
nitroglycerin that is used under the tongue. But if you don't have a headache
or feel burning or tingling under your tongue, it does not mean the medicine is
- Coronary Artery Disease
- Heart Attack and Unstable Angina
Other Works Consulted
Fraker TD, et al. (2007). 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group. Circulation, 116(23): 2762–2772.
O'Connor RE, et al. (2010). Acute coronary syndromes: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122(18): S787–S817.
O'Gara PT, et al. (2013). 2013 ACCF/AHA guideline for the management of
ST-elevation myocardial infarction: Executive summary. A Report of the American College of Cardiology Foundation/American
Heart Association Task Force on Practice Guidelines. Circulation, 127(4): e362–e425.
|By: ||Healthwise Staff ||Last Revised: April 4, 2011|
|Medical Review: ||E. Gregory Thompson, MD - Internal Medicine|
John M. Miller, MD, FACC - Cardiology, Electrophysiology
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