Nitrates are used to treat the symptoms of angina (chest pain). Depending on the type of dosage form and how it is taken, nitrates are used to treat angina in three ways:
Nitrates are available in different forms. Sublingual nitrates are generally placed under the tongue where they dissolve and are absorbed through the lining of the mouth. Some can also be used buccally, being placed under the lip or in the cheek. The chewable dosage forms, after being chewed and held in the mouth before swallowing, are absorbed in the same way. It is important to remember that each dosage form is different and that the specific directions for each type must be followed if the medicine is to work properly.
Nitrates that are used to relieve the pain of an angina attack include:
Those that can be used to prevent expected attacks of angina include:
Products that are used regularly on a long-term basis to reduce the number of attacks that occur include:
Nitrates work by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its work load.
Nitrates may also be used for other conditions as determined by your doctor.
These medicines are available only with your doctor's prescription.
Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Studies on these medicines have been done only in adult patients, and there is no specific information comparing use of nitrates in children with use in other age groups.
Dizziness or lightheadedness may be more likely to occur in the elderly, who may be more sensitive to the effects of nitrates.
Nitrates have not been studied in pregnant women. However, studies in rabbits given large doses of isosorbide dinitrate have shown adverse effects on the fetus. Before taking these medicines, make sure your doctor knows if you are pregnant or if you may become pregnant.
It is not known whether these medicines pass into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking these medicines and who wish to breast-feed should discuss this with their doctor.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other medical problems
The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:
Take this medicine exactly as directed by your doctor. It will work only if taken correctly.
To select a Sublingual tablets for use, pour several into the bottle cap, take one, and pour the others back into the bottle. Try not to hold them in the palm of your hand because they may pick up moisture and crumble.
Sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Place the tablet under the tongue, between the lip and gum, or between the cheek and gum and let it dissolve there. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving.
Buccal extended-release tablets should not be chewed, crushed, or swallowed. They are designed to release a dose of nitroglycerin over a period of hours, not all at once.
For patients using nitroglycerin or isosorbide dinitrate to relieve the pain of an angina attack:
For patients using nitroglycerin or isosorbide dinitrate to prevent an expected angina attack:
For patients using isosorbide dinitrate or extended-release buccal nitroglycerin regularly on a long-term basis to reduce the number of angina attacks that occur:
The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Keep out of the reach of children.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Do not keep outdated medicine or medicine no longer needed.
For sublingual nitroglycerin
Do not take sildenafil (e.g., Viagra), tadalafil (e.g., Cialis), or vardenafil (e.g., Levitra) if you are taking this medicine. When sildenafil, tadalafil, or vardenafil are taken with nitrates, the combination can lower blood pressure and cause dizziness, lightheadedness, or fainting. In some cases, sildenafil, tadalafil, or vardenafil taken with nitrates has caused death.
If you have been taking this medicine regularly for several weeks, do not suddenly stop using it. If you are taking sildenafil, tadalafil, or vardenafil and you experience an angina attack, you must go to the hospital right away. Stopping suddenly may bring on attacks of angina. Check with your doctor for the best way to reduce gradually the amount you are taking before stopping completely.
Dizziness, lightheadedness, or faintness may occur, especially when you get up quickly from a lying or sitting position. Getting up slowly may help. If you feel dizzy, sit or lie down.
The dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for long periods of time, exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time.
After taking a dose of this medicine you may get a headache that lasts for a short time. This is a common side effect, which should become less noticeable after you have taken the medicine for a while. If this effect continues or if the headaches are severe, check with your doctor.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.