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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Nitroglycerin
Generic Name
Nitroglycerin
Active Ingredient
NitroglycerinCategory
Nitrate Vasodilator [EPC]
Variants
61
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| .3 mg/1 | TABLET | SUBLINGUAL | 68462-638 |
| .6 mg/1 | TABLET | SUBLINGUAL | 69339-175 |
| .4 mg/1 | TABLET | SUBLINGUAL | 71872-7033 |
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Nitroglycerin, you must consult a qualified healthcare professional.
| .4 mg/1 | TABLET | SUBLINGUAL | 50090-3266 |
| 20 mg/g | OINTMENT | TOPICAL | 51662-1340 |
| .6 mg/1 | TABLET | SUBLINGUAL | 59762-0489 |
| .4 mg/1 | TABLET | SUBLINGUAL | 68071-3773 |
| .3 mg/1 | TABLET | SUBLINGUAL | 69339-173 |
| .4 mg/1 | TABLET | SUBLINGUAL | 70518-4277 |
| .1 mg/h | PATCH | TRANSDERMAL | 0378-9102 |
| .4 mg/1 | TABLET | SUBLINGUAL | 71872-7338 |
| .4 mg/1 | TABLET | SUBLINGUAL | 72603-266 |
+ 38 more variants
Detailed information about Nitroglycerin
Nitroglycerin is a potent nitrate vasodilator primarily used for the acute relief and prophylactic management of angina pectoris. It functions by relaxing vascular smooth muscle, thereby reducing myocardial oxygen demand and improving coronary blood flow.
Dosage for nitroglycerin is highly individualized based on the patient's response and the specific formulation used. Healthcare providers typically aim for the lowest effective dose to minimize side effects like headaches.
Nitroglycerin is generally not approved for use in pediatric populations. Safety and effectiveness have not been established in children. In rare, specialized pediatric cardiac intensive care cases, it may be used off-label under the direct supervision of a pediatric cardiologist, but this is not standard practice.
Specific dosage adjustments for patients with kidney disease are generally not required for nitroglycerin, as it is rapidly metabolized by the liver and vascular tissues. However, patients with severe renal impairment should be monitored for fluid balance if receiving intravenous formulations.
Because the liver is a primary site of metabolism, patients with severe hepatic cirrhosis may have reduced clearance of nitroglycerin. Healthcare providers typically use caution and monitor blood pressure closely in these individuals, though specific dose-reduction formulas are not standardized.
Older adults are often more sensitive to the hypotensive (blood pressure lowering) effects of nitroglycerin. Clinical guidelines suggest starting at the lower end of the dosing range. There is an increased risk of falls due to dizziness (orthostatic hypotension) in this population.
Proper administration is vital for the effectiveness of nitroglycerin:
For maintenance forms (patches or ointment), if you miss a dose, apply it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose. Do not apply two patches or a double dose of ointment to make up for a missed one, as this can cause dangerously low blood pressure.
An overdose of nitroglycerin can cause severe hypotension (very low blood pressure) and methemoglobinemia (a condition where the blood cannot carry oxygen effectively).
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop taking this medication without medical guidance.
Side effects of nitroglycerin are primarily related to its mechanism as a vasodilator. Because it widens blood vessels throughout the body, not just in the heart, several predictable reactions occur:
Nitroglycerin is a potent medication that requires careful handling and adherence to safety protocols. Patients must be aware that while it is highly effective for chest pain, it can significantly alter blood pressure and interact with other substances. Always sit or lie down when taking fast-acting nitroglycerin to prevent injury from fainting.
As of 2026, there are no FDA black box warnings for Nitroglycerin. However, clinical guidelines emphasize the extreme danger of mixing this drug with erectile dysfunction medications or certain pulmonary hypertension drugs.
The following medications must NEVER be used with Nitroglycerin. The interaction is considered life-threatening:
In certain clinical situations, the risks of nitroglycerin far outweigh any potential benefits. It must NEVER be used in the following cases:
Nitroglycerin is classified by the FDA as Pregnancy Category C. This means that animal reproduction studies have shown an adverse effect on the fetus, or there are no adequate and well-controlled studies in humans.
It is not known whether nitroglycerin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when nitroglycerin is administered to a nursing woman. Given the extremely short half-life of the drug, the risk to the infant may be low, but healthcare providers typically recommend monitoring the infant for signs of low blood pressure or irritability if the mother is using the medication.
Nitroglycerin is a potent vasodilator that acts through the exogenous supply of nitric oxide (NO). The molecular pathway involves several steps:
Common questions about Nitroglycerin
Nitroglycerin is primarily used to treat and prevent angina pectoris, which is chest pain caused by a lack of oxygen-rich blood flow to the heart muscle. It is also used in emergency medical settings to treat acute heart failure and dangerously high blood pressure. In its rectal ointment form, it is used to relieve pain associated with chronic anal fissures. The drug works by relaxing and widening blood vessels, which allows blood to flow more easily and reduces the workload on the heart. It is a critical rescue medication for people with known coronary artery disease.
The most common side effect of nitroglycerin is a headache, often referred to as a 'nitrate headache,' which is caused by the dilation of blood vessels in the brain. Other frequent side effects include flushing of the face and neck, dizziness, and lightheadedness, especially when standing up quickly. Some patients may also experience a rapid heartbeat (tachycardia) or a temporary feeling of weakness. These side effects are usually most intense when first starting the medication and often diminish as the body adjusts. If side effects become severe or persistent, you should contact your healthcare provider.
No, you should avoid drinking alcohol while taking nitroglycerin. Both alcohol and nitroglycerin cause blood vessels to dilate (widen), which can lead to a dangerously large drop in blood pressure when used together. This combination can cause severe dizziness, fainting, or even cardiovascular collapse. Even small amounts of alcohol can increase the risk of these side effects. If you have consumed alcohol, it is important to be extremely cautious and inform emergency medical personnel if you require nitroglycerin for chest pain.
Nitroglycerin is classified as Pregnancy Category C, meaning its safety in human pregnancy has not been well-established. Animal studies have shown potential risks, and there is a concern that severe drops in maternal blood pressure could reduce blood flow to the baby. Because of this, nitroglycerin is only used during pregnancy if the potential benefit to the mother clearly outweighs the potential risk to the fetus. If you are pregnant or planning to become pregnant, you must discuss the risks and benefits of this medication with your cardiologist and obstetrician.
The onset of action for nitroglycerin depends on the form being used. Sublingual tablets and translingual sprays are designed for rapid relief and typically begin working within 1 to 3 minutes, with the maximum effect occurring around 5 minutes. Topical ointments usually take 30 to 60 minutes to begin working, while transdermal patches have a slow onset and are used for long-term prevention rather than immediate relief. If you are using a fast-acting form and your chest pain does not improve within 5 minutes of the first dose, you should seek emergency medical help immediately.
You should never stop taking maintenance nitroglycerin, such as transdermal patches or daily ointments, without first consulting your doctor. Abruptly stopping the medication after long-term use can cause 'rebound' angina, where chest pain returns more frequently or more severely than before. In some cases, sudden discontinuation can even trigger a heart attack. If you need to stop the medication, your healthcare provider will usually provide a plan to gradually reduce your dose over several days or weeks to ensure your heart remains stable.
If you miss a dose of a maintenance form of nitroglycerin, such as a patch or ointment, apply it as soon as you remember. However, if it is nearly time for your next scheduled dose, skip the missed dose and return to your regular schedule. Do not apply extra medication or two patches at once to make up for a missed dose, as this can lead to dangerously low blood pressure. For the sublingual tablets used for acute pain, there is no 'missed dose' since they are only taken as needed for chest pain.
Nitroglycerin is not known to cause weight gain. It does not affect metabolism, appetite, or water retention in a way that would lead to an increase in body mass. If you experience sudden weight gain or swelling (edema) while taking nitroglycerin, it is more likely related to an underlying heart condition, such as heart failure, rather than the medication itself. You should report any rapid weight gain or swelling in your ankles or legs to your doctor immediately, as this may indicate that your heart condition requires a change in treatment.
Nitroglycerin has several significant drug interactions that must be managed by a doctor. It should never be taken with PDE5 inhibitors (like Viagra or Cialis) or riociguat, as the combination can be fatal. It can also interact with other blood pressure medications, antidepressants, and even some over-the-counter NSAIDs. Always provide your healthcare provider with a complete list of all prescription drugs, over-the-counter medicines, vitamins, and herbal supplements you are taking. This allows your doctor to monitor for potential interactions and adjust your treatment plan for safety.
Yes, nitroglycerin is available in several generic forms, which are typically much less expensive than brand-name versions. Generic sublingual tablets, transdermal patches, and ointments are widely available and are required by the FDA to have the same active ingredient, strength, and effectiveness as the brand-name products. When picking up your prescription, you can ask your pharmacist if a generic version is available for the specific form your doctor has prescribed. Regardless of whether you use a brand or generic, ensure the sublingual tablets are stored in their original glass container.
Other drugs with the same active ingredient (Nitroglycerin)
> Warning: Stop using Nitroglycerin and call your doctor or emergency services immediately if you experience any of the following:
No FDA black box warnings are currently issued for nitroglycerin. However, there is a Contraindication Warning that is treated with similar clinical gravity: Nitroglycerin must NEVER be used in combination with phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). This combination can cause a sudden and catastrophic drop in blood pressure that may be fatal.
Report any unusual symptoms to your healthcare provider. Many side effects, like the 'nitrate headache,' can be managed by adjusting the dose or using mild analgesics (painkillers) as recommended by your doctor.
If you are taking nitroglycerin long-term or receiving it intravenously, your healthcare provider will monitor several parameters:
Nitroglycerin can cause significant dizziness, lightheadedness, and blurred vision, especially during the first few days of treatment or when the dose is increased. You should not drive or operate heavy machinery until you know how the medication affects you. Alcohol can significantly worsen these effects.
Alcohol consumption is strongly discouraged while using nitroglycerin. Alcohol also dilates blood vessels and lowers blood pressure. When combined with nitroglycerin, the effect is additive, potentially leading to severe hypotension, fainting, and collapse.
Do not stop taking maintenance nitroglycerin (like patches or long-acting capsules) suddenly. Abruptly stopping the medication can lead to a 'rebound effect,' causing severe chest pain or even a heart attack. If the medication needs to be stopped, your doctor will provide a schedule to gradually taper the dose.
> Important: Discuss all your medical conditions, including any history of low blood pressure, anemia, or glaucoma, with your healthcare provider before starting Nitroglycerin.
Nitroglycerin may interfere with the Zlatkis-Zak color reaction, potentially resulting in falsely low serum cholesterol readings in laboratory tests. It does not typically affect standard blood counts or liver/kidney function tests.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, including those for erectile dysfunction or pulmonary hypertension.
In these situations, a healthcare provider must carefully weigh the risks and benefits before prescribing nitroglycerin:
Patients who have had an allergic reaction to other nitrate medications, such as Isosorbide Mononitrate or Isosorbide Dinitrate, are highly likely to be allergic to nitroglycerin as well. This is known as cross-sensitivity within the nitrate class. Additionally, some patients may be sensitive to the adhesives used in transdermal patches or the lanolin found in some nitroglycerin ointments.
> Important: Your healthcare provider will evaluate your complete medical history, including any recent head injuries or specific eye conditions, before prescribing Nitroglycerin.
Nitroglycerin is not approved for use in children. The safety, efficacy, and appropriate dosing for pediatric patients have not been established. Clinical use in children is extremely rare and limited to highly specialized cardiac intensive care environments under the direction of experts.
Patients aged 65 and older represent a significant portion of nitroglycerin users, but they require special consideration:
For patients with kidney disease, nitroglycerin is generally considered safe because it is primarily metabolized by the liver and blood vessels. However, the inactive ingredients in intravenous formulations (like propylene glycol) can accumulate in patients with severe renal failure if given in very high doses for long periods. Standard sublingual and transdermal doses do not require adjustment for GFR (glomerular filtration rate).
Since the liver is a major site of nitroglycerin metabolism, patients with severe liver disease (Child-Pugh Class C) may have higher levels of the drug in their system for longer periods. This increases the risk of side effects. Healthcare providers will monitor these patients closely for signs of excessive vasodilation and may reduce the frequency or dose of the medication.
> Important: Special populations require individualized medical assessment. Always inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding.
The pharmacodynamic response to nitroglycerin is dose-dependent. At low doses, it primarily dilates the veins, reducing the amount of blood returning to the heart (preload). This is the primary way it relieves angina. At higher doses, it also dilates the arteries, reducing the resistance the heart must pump against (afterload).
Tolerance: A key pharmacodynamic feature is the rapid development of tachyphylaxis (tolerance). Continuous exposure leads to the depletion of sulfhydryl groups or the inactivation of ALDH2, making the drug less effective. This is why a nitrate-free interval is clinically essential.
| Parameter | Value |
|---|---|
| Bioavailability | <1% (Oral), ~40-60% (Sublingual), ~70-90% (Transdermal) |
| Protein Binding | 60% |
| Half-life | 1 to 4 minutes |
| Tmax | 2-5 minutes (Sublingual), 2 hours (Patch) |
| Metabolism | Hepatic (Glutathione-organic nitrate reductase) and Vascular |
| Excretion | Renal (as metabolites) |
Nitroglycerin is the prototypical member of the Nitrate Vasodilator class. Related medications include Isosorbide Mononitrate and Isosorbide Dinitrate. While they share the same mechanism, nitroglycerin is unique for its rapid onset and short duration, making it the preferred choice for acute rescue therapy.