Nitroglycerin, Topical

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KEY POINTS

• This medicine is put on the skin to help prevent attacks of angina. Use 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, ointment; nitroglycerin, topical; Nitro-Bid

What is this medicine used for?

This medicine is an ointment used on the skin to help prevent attacks of chest pain (angina).

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 or adhesive
• A stroke or transient ischemic attack (TIA)
• Anemia
• Head injury or bleeding in the brain
• Heart failure, a heart attack, or other heart problems
• Glaucoma
• 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?

Check the label on the medicine for directions about your specific dose. Use this medicine exactly as directed by your healthcare provider. The medicine comes with patient instructions. Ask your healthcare provider or pharmacist if you have any questions.

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

This ointment is for external use only. Do not take by mouth.

Use the dose applicator or the dose-measuring paper that come with the ointment to measure the dose. Using the applicator or paper, spread a thin layer of ointment about the size of the applicator or paper over a clean, dry area of skin on the upper body where there is little or no hair. Avoid injured, irritated, calloused, or scarred skin. Do not rub the ointment into the skin. Tape the applicator or paper in place over the ointment to protect your clothing. Try not to get the ointment on your fingers. Wash your hands well after use. Remove the paper and clean the area before you apply the next dose. Use a different site each day to prevent skin irritation.

This medicine is usually used for only part of the day and then removed. Follow your healthcare provider's instructions carefully.

What if I miss a dose?

If you miss a dose of this medicine, apply it as soon as possible. If it is almost time to put on your next dose, wait until then to apply the ointment and skip the dose you missed. Do not apply extra ointment to make up for the missed dose. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

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, vision problems, trouble breathing, sweating, cold clammy skin, dizziness, weakness, nausea, vomiting, bloody diarrhea, 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.

Do not stop using this medicine without your healthcare provider's approval. Stopping this medicine suddenly may bring on attacks of chest pain.

You may have a headache for a short time after you start using this medicine. Treat headaches with aspirin or acetaminophen as directed by your healthcare provider. If the headaches continue or become severe, contact your provider.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may lessen this reaction. Alcohol may increase this reaction. Do not drink alcohol unless your healthcare provider approves.

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

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 using 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, blurred vision, increased sweating, blue lips or fingernails, fainting, severe or ongoing dizziness, increased chest pain; slow, fast, or irregular heartbeat; severe nausea or vomiting; unusual tiredness or weakness; severe skin irritation; confusion.

Other: Mild dizziness, flushing, short headache, redness or itching where you put the medicine, dry mouth, nausea.

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 other salicylates
• 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 the container tightly closed. Protect it from heat, high humidity, and bright light. Do not refrigerate.

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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.