Nitrostat (Nitroglycerin) - Sublingual

What Is Nitrostat?

Nitrostat (nitroglycerin) is an orally administered prescription medication used to treat angina (chest pain) in adults 18 and older who have coronary artery disease (CAD; the constriction of the blood vessels that deliver blood to the heart).

Nitrostat belongs to a class of drugs called nitrates, or vasodilators. Vasodilators are drugs used to open blood vessels, thereby keeping a person's veins and arteries from contracting and lessening the potential for obstructed blood flow.

Nitrostat contains the active ingredient nitroglycerin and works to relax and widen the blood vessels, a process that increases blood flow to the heart.

Nitrostat, containing the active ingredient nitroglycerin, is available as a therapeutically equivalent, generic product. Other forms of nitroglycerin are available, such as a sublingual (under the tongue) spray or sublingual tablet.

Additional brand-name, sublingual versions of nitroglycerin exist too, such as Nitromist and Nitrolingual Pumpspray.

However, this article will focus on the brand-name Nitrostat, available in the form of sublingual tablets that slowly dissolve under the tongue.

What Is Nitrostat Used For?

The Food and Drug Administration (FDA) has approved Nitrostat to treat angina due to CAD in adults 18 and older. Healthcare providers typically prescribe this medication on an as-needed basis.

Angina is a type of chest pain that occurs when the heart doesn’t receive enough blood. Common symptoms associated with Nitrostat include pain, pressure, or discomfort in your chest.

How to Take Nitrostat

Nitrostat can be used to stop angina or to help prevent it. Be sure to follow your provider’s instructions.

To stop chest pain after it’s started, you’ll place one tablet under the tongue. Allow the tablet to dissolve slowly without swallowing. If the pain doesn’t go away within five minutes, you can place another tablet under the tongue.

No more than three tablets should be taken in a 15-minute time period. If the chest pain still doesn’t go away after taking three tablets, or if it feels different from your typical angina symptoms, call 911 or seek immediate medical attention.

To prevent chest pain, place one tablet under the tongue for five to 10 minutes prior to physical activity that may trigger an angina attack.

People who experience xerostomia (dry mouth) may take a small sip of water before putting the nitroglycerin tablet under the tongue. Doing so will help the tablet dissolve.

It’s best to take this medication while seated and be careful to stand up slowly. This helps lower the risk of falling from lightheadedness, a common side effect.

Storage

Nitrostat tablets should be kept in a secure, dry location and kept at room temperature (68 F to 77 F). Secondly, be sure to keep out of reach of children and pets.

Only store the tablets in the original glass bottle they come in. Make sure to screw the lid on tightly after each use. Be mindful of the drug’s expiration date (as printed on the bottle), and be sure to order your next refill before your supply expires.

Off-Label Uses

In some cases, healthcare providers may use Nitrostat tablets off-label to quickly treat very blood pressure episodes, such as hypertensive emergencies. A hypertensive emergency occurs when blood pressure rises so high that it causes damage to an organ such as the heart, kidneys, or brain.

What Are the Side Effects of Nitrostat?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Like other medications, Nitrostat can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.

Common Side Effects

Common side effects of Nitrostat include:

• Headache
• Flushing
• Lightheadedness
• Dizziness or fainting
• Heart palpitations (an irregular heartbeat)
• Nausea

Of note, getting up slowly after sitting or lying down can help reduce the chance of lightheadedness and dizziness.

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

• A sudden drop in blood pressure: Dizziness, nausea, vomiting, weakness, excessive sweating, pale appearance, or fainting 
• Exfoliative dermatitis (a rare, but serious skin reaction): Red or discolored skin, scaling, crusting lesions, or swollen lymph nodes
  

Dosage: How Much Nitrostat Should I Take?

Modifications

The following modifications (changes) should be kept in mind when using Nitrostat:

Severe allergic reaction: Avoid using Nitrostat if you have a known allergy to it or its ingredients. Ask your healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: Limited studies on the use of Nitrostat are insufficient to determine a drug-associated risk of major birth defects or miscarriage. 

Discuss with your healthcare provider if you plan to become pregnant or are pregnant. They will help you weigh the benefits and risks of Nitrostat during your pregnancy.

Breastfeeding: Nitrostat has not been studied in lactating people. It is not known if Nitrostat is present in human milk or if it has effects on milk production.

Talk with your healthcare provider if you plan to breastfeed. Your healthcare provider will help you weigh the benefits and harms of taking penicillamine while nursing. They can also discuss the different ways available to feed your baby.

Older adults over 65: There is limited information about Nitrostat use in older adults to compare differences in responses between this age group and younger adults.

In general, dose selection for older adults should be conservative, typically starting at the low end of the dosing range to reflect the greater frequency of decreased liver, kidney, or heart function.

Children: There is limited effectiveness and safety information about Nitrostat in children. Nitrostat is approved for use in adults 18 and older.

Consumption adjustments: People who experience xerostomia may take a small sip of water before putting a tablet under their tongue, as this will help the tablet dissolve.

Missed Dose

If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose at the regular time. Do not take two doses to make up for a missed dose.

Overdose: What Happens If I Take Too Much Nitrostat?

While rare, an overdose of Nitrostat can result in the following:

• Severely low hypotension (low blood pressure)
• Heart palpitations
• Vision changes
• Excessive sweating
• Loss of consciousness

Additionally, consuming excessive amounts of Nitrostat may lead to paralysis, coma, and even death.

If you or someone else takes too much Nitrostat, seek immediate medical attention.

Precautions

What Are Reasons I Shouldn’t Take Nitrostat?

Nitrostat isn’t safe for everyone. You should not take Nitrostat if you:

• Have an allergy to nitroglycerin or other nitrates
• Have recently experienced a heart attack
• Have recently taken a PDE-5 inhibitor drug for the treatment of erectile dysfunction (ED), such as Viagra (sildenafil), Cialis (tadalafil), or vardenafil
• Have recently taken an sGC-stimulator drug for pulmonary hypertension, such as Adempas (riociguat).
• Have severe anemia

In addition, healthcare providers typically won’t prescribe Nitrostat to people experiencing increased intracranial pressure (such as cerebral hemorrhage or a traumatic brain injury), shock, or certain circulation problems.

What Other Medications Interact With Nitrostat?

Before starting treatment, tell your healthcare provider about your medications, including prescription and over-the-counter (OTC) drugs and vitamins or supplements.

Nitrostat can interact with certain medications. This section describes a few of the more common drug interactions, but others are possible:

• You should not take Nitrostat with a PDE-5 Inhibitor such as Viagra (sildenafil), Cialis (tadalafil), vardenafil, or an sGC-Stimulator (medications for the treatment of pulmonary hypertension), such as Adempas (riociguat) as these interactions can cause an unsafe drop in blood pressure that can be life-threatening.
• Nitrostat should not be taken with Ergomar (ergotamine) because this drug is known to cause angina, thus potentially making nitroglycerin less effective.

Consult your healthcare provider for a complete list of drug interactions.

What Medications Are Similar?

Besides Nitrostat (sublingual or “SL” nitroglycerin), other medications may be used to treat or prevent angina (chest pain), such as:

• Other forms of nitroglycerin, such as nitroglycerin sublingual spray or transdermal patches
• Other nitrates, such as Monoket (isosorbide)
• Beta-blockers such as Tenormin (atenolol) and Toprol-XL (metoprolol succinate)
• Antiplatelet drugs such as Plavix (clopidogrel) and Brilinta (ticagrelor)

This is not a list of drugs recommended to take with Nitrostat. Talk to your healthcare provider if you have any questions.

How Can I Stay Healthy While Taking Nitrostat?

An angina diagnosis can be scary. The good news is that people with well-controlled angina can live a normal life doing the things they enjoy. The only difference is that you’ll need to keep your bottle of Nitrostat nearby in case symptoms of angina arise.

To help control your angina, taking all your medications as prescribed is important. It’s also essential to follow your provider’s advice for managing other chronic conditions, such as high blood pressure, type 2 diabetes, or high cholesterol.

Taking Nitrostat is just one part of a comprehensive plan for reducing your risk of severe heart problems. Lifestyle modifications, such as diet and exercise, are another key part of the plan.

However, strenuous physical activity may not be safe if you have heart disease. Your healthcare provider can advise you on the right fitness routines for you.