nitroglycerin ER
Nitroglycerin ER (Nitro-Time) is a nitrate medication. Nitroglycerin ER (Nitro-Time) capsules are taken by mouth, typically 3 or 4 times per day, to prevent angina (chest pain) in adults. Unlike some other nitroglycerin medications, such as nitroglycerin (Nitrostat) sublingual tablet, nitroglycerin ER (Nitro-Time) isn't able to treat chest pain that has already started. Side effects include headache and low blood pressure. Nitroglycerin ER (Nitro-Time) is a brand-name medication and isn't available as a generic.
What is Nitroglycerin ER (Nitro-Time)?
What is Nitroglycerin ER (Nitro-Time) used for?
- Prevention of angina (chest pain due to tight blood vessels in the heart)
How Nitroglycerin ER (Nitro-Time) works
Nitroglycerin ER (Nitro-Time) is a nitrate. This medication causes the blood vessels in your heart to open up (dilate). This helps blood reach the heart better. More blood flow to the heart puts less stress on the heart and relieves heart-related chest pain.
Drug facts
Side effects of Nitroglycerin ER (Nitro-Time)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache
Less Common Side Effects
- Temporary lightheadedness from lower blood pressure
- Fainting
Nitroglycerin ER (Nitro-Time) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Dangerously low blood pressure: dizziness, lightheadedness, pale skin, feeling faint
The following Nitroglycerin ER (Nitro-Time) 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:
Less common
Bloating or swelling of the face, arms, hands, lower legs, or feet
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
difficult or labored breathing
feeling faint, dizzy, or lightheadedness
feeling of warmth or heat
flushing or redness of the skin, especially on the face and neck
headache
rapid weight gain
sweating
tightness in the chest
tingling of the hands or feet
unusual weight gain or loss
Rare
Bluish-colored lips, fingernails, or palms
dark urine
pale skin
rapid heart rate
unusual bleeding or bruising
unusual tiredness or weakness
Incidence not known
Arm, back, or jaw pain
blurred vision
chest pain or discomfort
chest tightness or heaviness
confusion
cracks in the skin
difficulty with swallowing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast, irregular, pounding, or racing heartbeat or pulse
feeling of constant movement of self or surroundings
feeling of warmth
increased sweating
loss of heat from the body
nausea or vomiting
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red, swollen skin
redness of the face, neck, arms, and occasionally, upper chest
sensation of spinning
weakness
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Bluish-colored lips, fingernails, or palms
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
dark urine
difficulty breathing
disturbed color perception
dizziness or lightheadedness
double vision
flushed skin
halos around lights
headache, severe and throbbing
increased sweating
loss of appetite
loss of consciousness
night blindness
overbright appearance of lights
pale skin
paralysis
slow or irregular heartbeat
tunnel vision
unusual bleeding or bruising
unusual tiredness or weakness
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:
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.
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Pros and cons of Nitroglycerin ER (Nitro-Time)
Pros
- Helps prevent chest pain, including pain due to exercise
- Taken by mouth
- Available in multiple strengths
Cons
- Must be taken 3 to 4 times a day
- Available as a brand-name product only
- Not for treating chest pain after it has started
Pharmacist tips for Nitroglycerin ER (Nitro-Time)
- Nitroglycerin ER (Nitro-Time) is meant to be taken every day to help prevent chest pain; it doesn't treat chest pain that has already started. Your cardiologist can talk with you about what medication you can take for treating chest pain.
- Swallow nitroglycerin ER (Nitro-Time) whole. Don't chew, cut, crush, or open the capsules, because this can make the medication release too quickly and cause more side effects. If you are having trouble swallowing the capsule whole, let your prescriber know right away because you'll likely need to be switched to a different medication.
- Your cardiologist will likely tell you to avoid taking nitroglycerin ER (Nitro-Time)) for a 10 to 12 hour period every day (usually overnight) to avoid tolerance. Tolerance is when the medication doesn't work as well because you have been taking it for a long time without any breaks.
- Nitroglycerin ER (Nitro-Time) can cause headaches as a side effect. As long as the headache is bearable, try not to change the timing of the doses. If the headaches are too bothersome for you, ask your prescriber if it's safe for tips and tricks to treat them, or if you can take a pain medication, such as acetaminophen (Tylenol).
- Nitroglycerin ER (Nitro-Time) can lower your blood pressure, which can lead to dizziness, lightheadedness, or fainting. To prevent falls, get up slowly from a sitting position. Make sure to hold on to something stable for support as you're standing.
- Avoid drinking alcohol while taking nitroglycerin ER (Nitro-Time). Doing so can raise your risk of headaches and low blood pressure.
- Make sure to tell your care team about all of the medications you take because nitroglycerin ER (Nitro-Time) interacts with certain medications. Examples include Adempas (riociguat), sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca). When taken together, your blood pressure can become dangerously low.
Common questions about Nitroglycerin ER (Nitro-Time)
Yes. Nitrates, like nitroglycerin ER (Nitro-Time), can lower your blood pressure. This is because they relax your blood vessels to allow blood to flow through easier. But having lower blood pressure can lead to side effects like light-headedness and dizziness. Rarely, this can lead to fainting. To lower the risk of falls, get up slowly from a sitting position. To prevent your blood pressure from dropping too low, it's important to stay hydrated with enough fluids. Depending on your risk for low blood pressure, your prescriber might recommend regularly measuring your blood pressure at home. Seek medical help right away if you feel dizzy, lightheaded, or faint because these might be signs your blood pressure is too low.
Yes. Nitroglycerin ER (Nitro-Time) is a vasodilator, meaning it dilates (opens) the blood vessels.
Sometimes, people experience chest pain (angina) because there isn't enough blood flowing to the heart. Nitroglycerin ER (Nitro-Time) prevents chest pain by opening up the blood vessels so that the blood flows better. Keep in mind that nitroglycerin ER (Nitro-Time) is taken to prevent chest pain. But this medication doesn't work quickly enough to relieve chest pain if you're already experiencing symptoms.
Ask your cardiologist about the specific times you should take nitroglycerin ER (Nitro-Time). It's typically taken three to four times per day. And because you'll need a nitrate-free period of about 10 to 12 hours to prevent tolerance, your prescriber will likely have you take nitroglycerin ER (Nitro-Time) every 3 to 4 hours during a 12-hour period.
Nitroglycerin ER (Nitro-Time) can start to work to relieve chest pain about 1 hour after a dose. But some people might not notice its effects until 2-4 hours after a dose. Since nitroglycerin ER (Nitro-Time) takes a while to kick in, it isn't recommended to treat chest pain that has already started.
The effects of nitroglycerin ER (Nitro-Time) last might last 5 to 12 hours after a dose. This can differ from person to person. Only take nitroglycerin ER (Nitro-Time) as directed by your prescriber.
No, nitroglycerin ER (Nitro-Time) itself doesn't stop a heart attack nor does it help to treat chest pain from a heart attack that has already started. It's only used to prevent chest pain from happening. Angina (chest pain) and heart attacks are both caused by not having enough blood reaching your heart. Having angina is your body’s way of telling you that your heart is at risk for damage. On the other hand, heart attacks happen when the lack of blood flow to the heart leads to actual damage to the heart itself. Nitroglycerin ER (Nitro-Time) opens up your blood vessels to improve blood flow to the heart to prevent chest pain, but it can’t fix an already damaged heart.
Yes, nitroglycerin ER (Nitro-Time) is still available as a brand-name product only.
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Risks and warnings for Nitroglycerin ER (Nitro-Time)
Nitroglycerin ER (Nitro-Time) 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 nitroglycerin ER (Nitro-Time)
Your body can get used to nitroglycerin ER (Nitro-Time) 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 nitroglycerin ER (Nitro-Time) 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 nitroglycerin ER (Nitro-Time) 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 nitroglycerin ER (Nitro-Time)).
Low blood pressure
- Risk factors: Taking nitroglycerin ER (Nitro-Time) while standing | Certain heart problems | Dehydration | Use of erectile dysfunction medications | Use of blood pressure-lowering medications | Alcohol use
Nitroglycerin ER (Nitro-Time) can cause your blood pressure to drop too much, which can make you feel dizzy, tired, or lightheaded. When you use nitroglycerin ER (Nitro-Time), 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 worsening chest pain.
Worsening chest pain
- Risk factors: Hypertrophic cardiomyopathy
Although rare, taking nitroglycerin ER (Nitro-Time) 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 nitroglycerin ER (Nitro-Time) is right for you. If you take nitroglycerin ER (Nitro-Time) dose and it worsens your chest pain, get emergency help right away.
Headache
- Risk factors: First starting nitroglycerin ER (Nitro-Time) | Higher doses of nitroglycerin ER (Nitro-Time) | Drinking alcohol
Some people experience daily headaches after starting nitroglycerin ER (Nitro-Time). 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 you've used nitroglycerin ER (Nitro-Time) a few times and your body gets used to the medication. If the headaches are bothersome, talk to your healthcare professional about other options.
Nitroglycerin ER (Nitro-Time) dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2.5mg | 90 capsules | $34.00 | $0.38 |
| 6.5mg | 30 capsules | $16.43 | $0.55 |
| 9mg | 30 capsules | $1.69 | $0.06 |
Typical dosage for Nitroglycerin ER (Nitro-Time)
- Adults: The typical starting dose ranges from 2.5 mg to 6.5 mg by mouth 3 to 4 times per day. Your prescriber will adjust your dose based on how well the medication is working for you and if you're having side effects.
Interactions between Nitroglycerin ER (Nitro-Time) and other drugs
More on Nitroglycerin ER (Nitro-Time) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
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
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Nitroglycerin ER (Nitro-Time) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Nitroglycerin ER (Nitro-Time) will not be safe for you to take.
- Allergy to other nitrates, such as isosorbide mononitrate (Monoket) or isosorbide dinitrate (Isordil)
