Using nitroglycerin for sudden chest pain

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Using nitroglycerin for sudden chest pain

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—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 a quick-acting tablet or spray form or as a long-acting pill. The quick-acting pill or spray forms are used under the tongue (sublingually). Your health professional will prescribe the right amount for you. Do not use another person's nitroglycerin.

When do I use nitroglycerin under the tongue?

Your health professional will advise you when to use your nitroglycerin. Generally, nitroglycerin under the tongue is used:

• To relieve sudden angina.
• Before stressful activities that can cause angina, such as walking uphill or having sexual intercourse.

How do I use nitroglycerin under the tongue?

• 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.
  • The tablet should be placed under your tongue and left until it dissolves. If you accidentally swallow the tablet, take another. The medicine won't work if it is swallowed.
  • To use the spray, lift your tongue and depress the spray canister button once.
• Take 1 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 calling 911 , continue to stay on the phone with the emergency operator—he or she will give you further instructions.

• Regardless of what happens, you should let your health professional know that you had an episode of angina. If this is unusual for you or if your angina episodes are occurring more frequently or lasting longer or you need more medicine to control them, tell your health professional. Report any change in your chest pain (unstable angina) to your health professional.

A fresh tablet should taste bitter and sting when you put it under your tongue. If it does not, it probably is not effective and you should take another.

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 tongue.

Do not take the erection-enhancing medicines sildenafil (Viagra), vardenafil (Levitra), or 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 health professional 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?

Store 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 and 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 not working.

Credits

Last updated:	May 14, 2007
Author:	Robin Parks, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC