Nitro-Bid
Nitro-Bid (nitroglycerin) is a nitrate ointment used in adults to help prevent angina, which is chest pain due to tight blood vessels in the heart. It's considered a vasodilator that works to open up your blood vessels. Nitro-Bid (nitroglycerin) is applied directly on the skin and used twice per day, once in the morning and then again 6 hours later. Side effects include headache and low blood pressure. Currently, it's only available as a brand name medication.
What is Nitro-Bid (nitroglycerin)?
What is Nitro-Bid (nitroglycerin) used for?
Prevention of angina (chest pain due to tight blood vessels in the heart)
How Nitro-Bid (nitroglycerin) works
Nitro-Bid (nitroglycerin) is a nitrate. It works by relaxing and opening up blood vessels in the body. This helps blood reach the heart better, which puts less stress on the heart and prevents heart-related chest pain.
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What are the side effects of Nitro-Bid (nitroglycerin)?
Common Side Effects
- Headache
- Low blood pressure
- Lightheadedness
Other Side Effects
- Fainting
- Allergic reaction
Serious Side Effects
- Dangerously low blood pressure: dizziness, lightheadedness, pale skin, feeling faint
Source: DailyMed
The following side effects have also been reported
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 immediately if any of the following side effects occur:
More common
Lightheadedness
Less common
Arm, back, or jaw pain
blurred vision
chest pain or discomfort
chest tightness or heaviness
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast or irregular heartbeat
sweating
unusual tiredness or weakness
Rare
Bluish-colored lips, fingernails, or palms
dark urine
difficulty with breathing
headache
pale skin
rapid heart rate
unusual bleeding or bruising
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Blurred or loss of vision
bulging soft spot on the head of an infant
change in consciousness
change in the ability to see colors, especially blue or yellow
cold, clammy skin
disturbed color perception
double vision
feeling of constant movement of self or surroundings
halos around lights
headache, severe and throbbing
loss of consciousness
night blindness
overbright appearance of lights
paralysis
sensation of spinning
tunnel vision
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:
Rare
Burning, itching, redness, skin rash, swelling, or soreness at the application site
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Nitro-Bid (nitroglycerin)
Pros
Prevents chest pain for up to 7 hours after a single application
Applied directly on the skin
Comes as single-dose packets that are easy to carry around and can be kept in many places at once
Cons
Doesn't work to treat sudden chest pain
Can be a hassle to put on since it might require plastic kitchen wrap to keep the application in place
Can be messy and stain clothing
Pharmacist tips for Nitro-Bid (nitroglycerin)
Nitro-Bid (nitroglycerin) is only for preventing chest pain; it doesn't treat chest pain that has already started. Your cardiologist might also prescribe forms of nitroglycerin, like the spray or sublingual tablet to treat chest pain quickly.
Nitro-Bid (nitroglycerin) commonly causes daily headaches. Headaches usually mean that the medication is working. If they become too bothersome, discuss with your prescriber the best way to manage them.
Nitro-Bid (nitroglycerin) can lower your blood pressure, which can lead to dizziness, lightheadedness, or fainting. Avoid alcohol because it can worsen dizziness and lower your blood pressure more.
Make sure to tell your care team about all of the medications you take because Nitro-Bid (nitroglycerin) interacts with certain medications. For example taking PDE-5 inhibitors, like sildenafil (Viagra) and tadalafil (Cialis), with Nitro-Bid (nitroglycerin) can cause your blood pressure to become dangerously low.
Most people apply Nitro-Bid (nitroglycerin) on their chest, but you can choose a different area if you prefer. Just make sure it's a spot you can easily reach, as you might need to cover the site with tape or plastic wrap and later wipe it off.
How to apply Nitro-Bid (nitroglycerin)
Measure your dose using the paper applicator included with the medication. Lay the applicator flat, printed side down. Squeeze the ointment onto the applicator, then place it ointment-side down on the application site.
Spread the ointment using the paper applicator lightly. Don't rub or massage it into the skin. Cover the area with medication to match the size of the applicator, which measures about 3½ inches by 2¼ inches. A larger area can be used, if needed.
Tape the applicator onto your skin so it stays in place and doesn't move or fall off. Completely cover the applicator. To avoid staining clothing, you can wrap it with plastic kitchen wrap.
You'll need to take the applicator off and wipe the medication off for 10 to 12 hours each day. It's recommended to do this in the evening and overnight. Removing Nitro-Bid (nitroglycerin) allows your body to have a "nitrate-free" period. This is so you don't build a tolerance to the medication. Otherwise, it might not work as well to prevent chest pain.
Frequently asked questions about Nitro-Bid (nitroglycerin)
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What are the risks and warnings for Nitro-Bid (nitroglycerin)?
Nitro-Bid (nitroglycerin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Tolerance
Risk factors: Use of long-acting nitrates | Taking too many doses of Nitro-Bid (nitroglycerin)
Your body can get used to Nitro-Bid (nitroglycerin) over time. When this happens, the same amount of medication might no longer work as well as it used to. This is called tolerance or tachyphylaxis. Tolerance to Nitro-Bid (nitroglycerin) is more likely to happen if you’ve taken longer-acting forms of nitrates (e.g., isosorbide mononitrate (Monoket) or isosorbide dinitrate (Isordil)). When you develop tolerance, taking a higher dose of medication won't help it work better. Because of this risk, make sure to take Nitro-Bid (nitroglycerin) at the prescribed dose and talk to your prescriber if you notice worsening chest pain. To prevent tolerance, your prescriber will ask you to schedule a nitrate-free period (about 10-12 hours when you're not taking Nitro-Bid (nitroglycerin)).
Low blood pressure
Risk factors: Taking Nitro-Bid (nitroglycerin) while standing | Certain heart problems | Dehydration | Use of erectile dysfunction medications | Use of blood pressure-lowering medications | Alcohol use
Nitro-Bid (nitroglycerin) can cause your blood pressure to drop too much, which can make you feel dizzy, tired, or lightheaded. When you use Nitro-Bid (nitroglycerin), make sure to sit down for the first few minutes to avoid dizziness or fainting. Change positions slowly until your body is used to the medication. Get emergency help if you feel like you're going to pass out in addition to having an irregular heartbeat, nausea, vomiting, weakness, changes in vision, sweating, cold and clammy skin, or worse chest pain.
Worsening chest pain
Risk factors: Hypertrophic cardiomyopathy
Although rare, taking Nitro-Bid (nitroglycerin) can worsen chest pain that's caused by a heart problem called hypertrophic cardiomyopathy. This is a condition where your heart muscles are too thick and can't pump blood as well. If you’ve been diagnosed with hypertrophic cardiomyopathy, check with your prescriber to make sure that this medication is right for you. If you take a Nitro-Bid (nitroglycerin) dose and it worsens your chest pain, get emergency help right away.
Headache
Risk factors: First starting Nitro-Bid (nitroglycerin) | Higher doses of Nitro-Bid (nitroglycerin) | Drinking alcohol
Some people experience daily headaches after starting Nitro-Bid (nitroglycerin). Sometimes, these headaches happen as you go from a sitting or lying position to a standing position. The headaches often ease or go away after your body gets used to the medication. If the headaches are bothersome, talk to your healthcare professional about other options.
Nitro-Bid (nitroglycerin) dosage forms
Typical dosing for Nitro-Bid (nitroglycerin)
The typical starting dose is ½ an inch twice per day. Your prescriber will adjust the dose based on how well you respond to the medication.
The ointment should be applied on the skin of the chest (or other area of the body, if preferred) first thing in the morning (or when you wake up) and then about 6 hours later.
Interactions between Nitro-Bid (nitroglycerin) and other drugs
More on Nitro-Bid (nitroglycerin) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Avanafil
- Riociguat
- Sildenafil
- Tadalafil
- Vardenafil
Using this medicine 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.
- Alteplase, Recombinant
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acetylcysteine
- Apomorphine
- Aspirin
- Dihydroergotamine
- Pancuronium
How much does Nitro-Bid (nitroglycerin) cost?
Nitro-Bid (nitroglycerin) contraindications
Allergy to other nitrates, such as isosorbide mononitrate (Monoket) or isosorbide dinitrate (Isordil)
What are alternatives to Nitro-Bid (nitroglycerin)?
Nitro-Bid (nitroglycerin) images
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References
Best studies we foundKala, R., et al. (1983). Nitroglycerin ointment effective for seven hours in severe angina pectoris. Journal of Internal Medicine.
Lee, P. M., et al. (2023). Nitrates. StatPearls.
Münzel, T., et al. (2011). Nitrate therapy: New aspects concerning molecular action and tolerance. Circulation.
Savage Laboratories a division of Fougera Pharmaceuticals Inc. (2024). Nitro-Bid- nitroglycerin ointment [package insert]. DailyMed.
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