Nitroglycerin, Sublingual/Translingual

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KEY POINTS

• This medicine is used in the mouth to prevent and relieve angina. Take it exactly as directed.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Taking riociguat, avanafil, sildenafil, tadalafil, or vardenafil while taking this medicine may cause severe or life-threatening low blood pressure. Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: nitrate; vasodilator

Generic and brand names: nitroglycerin, sublingual; nitroglycerin, translingual; GoNitro; Nitrolingual; Nitrostat; NitroMist

What is this medicine used for?

This medicine is used to prevent and relieve angina (chest pain).

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• A stroke or transient ischemic attack (TIA)
• Anemia
• Glaucoma
• Head injury or bleeding in the brain
• Heart failure, a heart attack, or other heart problems
• Low blood pressure
• Thyroid problems

Tell your provider if you take medicine to treat erectile dysfunction or pulmonary hypertension. You should not take some medicines while you are taking this medicine. Using these medicines together may cause severe or life-threatening low blood pressure.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

This medicine comes in several forms that you take by mouth. Some forms of this medicine are used only when you start to feel chest pain, while other forms are taken daily. Check the label on the medicine for directions about your specific dose. Be sure you know how many tablets, packets, or sprays you can take, how often you can take them, and when you may need to get medical help. If you are not sure how to take this medicine, ask your healthcare provider.

Follow your healthcare provider's instructions exactly. Do not run out of this medicine. Be sure you know when you need to get a refill.

Check with your healthcare provider before using this medicine in children under age 18.

Be sure you know how to use your medicine. You should sit down before you use this medicine.

Sublingual Tablet. 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. Do not chew, crush, or swallow the tablets. You may feel a slight tingling or stinging sensation when the medicine is dissolving.

Sublingual Powder. Empty 1 or 2 packets of powder under the tongue at the start of an angina attack. Let the powder dissolve without swallowing. It is best to sit or rest while the medicine dissolves. Do not rinse or spit for 5 minutes after you take a dose. Do not use more than 3 packets in a 15 minute period.

Translingual. This medicine is in the form of an aerosol spray that is sprayed onto or under the tongue. Follow directions on the medicine package for priming the aerosol spray bottle before using it the first time, and if the medicine has not been used for 6 weeks. Do not shake the container. Do not inhale the spray. Do not spit out the medicine and do not rinse your mouth for 5 to 10 minutes after using the medicine. Do not use it near flames or while smoking.

Follow your healthcare provider's directions for the use of this medicine.

This medicine should relieve your pain within 5 minutes after you take it. If the medicine does not relieve your chest pain or discomfort after the first dose, contact your healthcare provider or call 911 or your local emergency services away.

Do not increase your dosage without your healthcare provider's approval. Too much of this medicine may cause severe headaches.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: severe headache, confusion, fever, fast or pounding heartbeat, dizziness, vision problems, nausea, vomiting, bloody diarrhea, trouble breathing, sweating, cold clammy skin, lightheadedness, fainting, seizures.

What should I watch out for?

Do not take riociguat (Adempas), avanafil (Stendra), sildenafil (Viagra, Revatio), vardenafil (Levitra, Staxyn), or tadalafil (Cialis, Adcirca) while you are taking this medicine. Using these medicines together may cause severe or life-threatening low blood pressure.

Tell your healthcare provider if you think this medicine is not working as well as it did when you first started using the medicine.

You may have a brief headache after each dose when you start taking this medicine. Treat headaches with aspirin or acetaminophen as directed by your healthcare provider. If the headaches continue or are severe, contact your provider.

This medicine may make you dizzy. Do not drive or operate machinery unless you are fully alert.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help. Also, drinking alcohol may make it worse. Do not drink alcohol unless your healthcare provider approves.

Adults over the age of 65 may be at greater risk for side effects from this medicine. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Severe headache; dry mouth; blurred vision; blue lips or fingernails; severe or ongoing dizziness; fainting; slow, fast, or irregular heartbeat; increased chest pain; confusion.

Other: Mild dizziness, short headache, sweating, flushing, weakness, dry mouth, nausea, vomiting.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace)
• Acetylcysteine (Mucomyst)
• Alpha blockers such as doxazosin (Cardura), prazosin (Minipress), and terazosin
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antidepressants such as amitriptyline, desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Pamelor)
• Antipsychotic medicines such as chlorpromazine, perphenazine, prochlorperazine (Compro), thioridazine, and trifluoperazine
• Aspirin and medicines that contain aspirin
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carteolol, esmolol (Brevibloc), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), pindolol, sotalol (Betapace, Sorine), and timolol
• Blood pressure medicines such as hydralazine, methyldopa, minoxidil, and reserpine
• Calcium channel blockers such as diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), and verapamil (Calan, Covera, Verelan)
• Clonidine (Catapres, Kapvay)
• Decongestants such as oxymetazoline (Afrin, Dristan), phenylephrine (Neo-Synephrine, Sudafed PE), and pseudoephedrine (Sudafed)
• Diuretics (water pills) such as bumetanide, chlorthalidone, furosemide (Lasix), hydrochlorothiazide (Microzide), and metolazone (Zaroxolyn)
• Doxepin (Silenor)
• Eplerenone (Inspra)
• Erectile dysfunction medicines such as avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxyn). Using these medicines together is life threatening.
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines to treat or prevent blood clots such as alteplase (Activase) and heparin
• Medicines to treat pulmonary hypertension such as riociguat (Adempas), sildenafil (Revatio), and tadalafil (Adcirca). Using these medicines together is life threatening.
• Migraine medicines such as dihydroergotamine (D.H.E. 45, Migranal) and ergotamine (Ergomar)
• Natural remedies such as black cohosh, California poppy, goldenseal, hawthorn, periwinkle, shepherd's purse, and St. John's wort
• Obinutuzumab (Gazyva)
• Pentoxifylline
• Propranolol (Hemangeol, Inderal, InnoPran)
• Rosiglitazone (Avandia)

Do not drink alcohol while you are taking this medicine without your healthcare provider’s approval.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep this medicine in its original container. Keep the container tightly closed. Protect it from heat, high humidity, and bright light. Keep the medicine from freezing.

If you have the spray form, store it in an upright position. Do not puncture, break, or burn the container. The spray form is flammable.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.