nitroglycerin
Nitroglycerin (Nitrostat) is a fast-acting medication that’s used to prevent and treat angina (or chest pain). It helps with angina by allowing more blood to flow to the heart. Nitroglycerin (Nitrostat) is a tablet that’s placed under your tongue or against the cheek inside your mouth. Side effects include low blood pressure and headache. Nitroglycerin (Nitrostat) is available as a brand-name and generic medication.
What is Nitroglycerin (Nitrostat)?
What is Nitroglycerin (Nitrostat) used for?
Prevention and treatment of angina (chest pain due to tight blood vessels in the heart)
How Nitroglycerin (Nitrostat) works
Nitroglycerin (Nitrostat) 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
More on Nitroglycerin (Nitrostat) essentials
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What are the side effects of Nitroglycerin (Nitrostat)?
Common Side Effects
- Low blood pressure
- Headache
- Tingling or burning feeling in the mouth
Other Side Effects
- Dizziness
- Weakness
- Chest pounding
- Fainting
- Warm skin or skin redness (flushing)
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:
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.
Pros and cons of Nitroglycerin (Nitrostat)
Pros
Works well to relieve heart-related chest pain
Works quickly (within 1 to 3 minutes)
Can be used to prevent chest pain due to activities like exercise
Available as a lower-cost generic form
Cons
Can cause bothersome headaches
Can cause low blood pressure
Can't take with alcohol
Same dose might not work as well over time (develop tolerance to the medication)
Pharmacist tips for Nitroglycerin (Nitrostat)
Take nitroglycerin (Nitrostat) by placing it under your tongue or against one side of your mouth between the gums and inside of the cheek. Make sure it’s fully dissolved before swallowing. Don't chew, crush, or swallow the tablet whole.
For most people, the tablet will dissolve by itself in the mouth. But if you have dry mouth, you might need a small sip of water before placing the tablet in your mouth to help it dissolve.
Your chest pain should get better within 1 to 3 minutes after you take nitroglycerin (Nitrostat). If it doesn't, you can take another tablet 5 minutes later. You can take a total of up to 3 doses within 15 minutes. Get emergency help if you're still having chest pain after 3 doses or if the pain is different than usual.
Nitroglycerin (Nitrostat) can cause low blood pressure, which can lead to dizziness, lightheadedness, or fainting. Sit down before and after taking this medication to lower your risk of fainting or falling.
Avoid alcohol after you take a nitroglycerin (Nitrostat) tablet. Drinking alcohol while you’re taking this medication can lower your blood pressure and worsen dizziness. This can raise your risk for a fall.
Make sure to tell your provider the name of all the medications you take. This is because you can’t use nitroglycerin (Nitrostat) if you’re also taking medications like Adempas (riociguat), sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca), vardenafil (Levitra), or Stendra (avanafil). When taken together, your blood pressure can become dangerously low. If you’re having chest pain but have recently taken one of these medications, it's best to get emergency help right away. Don’t take nitroglycerin (Nitrostat) unless a healthcare provider says it's safe to do so.
Keep your bottle of nitroglycerin (Nitrostat) with you at all times since chest pain can happen at any time or when you aren't expecting it. Keep the tablets in the original glass bottle it comes in to protect them from light and to prevent damage to the medication.
Frequently asked questions about Nitroglycerin (Nitrostat)
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What are the risks and warnings for Nitroglycerin (Nitrostat)?
Nitroglycerin (Nitrostat) 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 (Nitrostat)
Your body can get used to nitroglycerin (Nitrostat) 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 (Nitrostat) is more likely to happen if you’ve taken longer-acting forms of nitrates (e.g., isosorbide mononitrate (Monoket) or isosorbine dinitrate (Isordil)). You can also develop tolerance to nitroglycerin (Nitrostat) if you use the medication too many times. When you develop tolerance, taking a higher dose of medication might not always help it to work better. Because of this risk, make sure to take nitroglycerin (Nitrostat) only when you need it at the prescribed dose and talk to your provider if you notice worsening chest pain.
Low blood pressure
Risk factors: Taking nitroglycerin (Nitrostat) while standing | Certain heart problems | Dehydration | Use of erectile dysfunction medications | Use of blood pressure-lowering medications | Alcohol use
Nitroglycerin (Nitrostat) can cause your blood pressure to drop too much, which can make you feel dizzy, tired, or lightheaded. When you take nitroglycerin (Nitrostat), 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.
Worse chest pain
Risk factors: Hypertrophic cardiomyopathy
Although rare, taking nitroglycerin (Nitrostat) 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 provider to make sure that nitroglycerin (Nitrostat) is right for you. If you take nitroglycerin (Nitrostat) dose and it worsens your chest pain, seek emergency help right away.
Headache
Risk factors: First starting nitroglycerin (Nitrostat) | Higher doses of nitroglycerin (Nitrostat)
Nitroglycerin (Nitrostat) can cause headaches, which can sometimes be severe. These headaches can last for up to an hour, but they can also be long-lasting. In particular, headaches can happen when you first start using nitroglycerin (Nitrostat) or if you take higher doses of the medication. But they can be less bothersome or happen less often after you've used nitroglycerin (Nitrostat) a few times and your body gets used to the medication. If the headaches are causing you too many problems, talk to your healthcare provider about other options.
Nitroglycerin (Nitrostat) dosage forms
Typical dosing for Nitroglycerin (Nitrostat)
Nitroglycerin (Nitrostat) is placed under the tongue or against one side of your mouth between the gums and inside of the cheek. Let it fully dissolve in your mouth before swallowing. Don't chew, crush, or swallow the tablet whole.
Treatment of chest pain: The typical dose is one tablet (0.3 mg, 0.4 mg, or 0.6 mg) at the first sign of chest pain. You can take another dose every 5 minutes as needed if you aren’t getting any relief. But don't take more than 3 tablets in a 15-minute period; get medical help if you still have chest pain.
Prevention of chest pain: The typical dose is one tablet (0.3 mg, 0.4 mg, or 0.6 mg) 5 to 10 minutes before doing any activity that could cause chest pain.
More on Nitroglycerin (Nitrostat) dosage forms
Interactions between Nitroglycerin (Nitrostat) and other drugs
More on Nitroglycerin (Nitrostat) 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 Nitroglycerin (Nitrostat) cost?
Nitroglycerin (Nitrostat) contraindications
Taking PDE-5 inhibitors like sildenafil (Viagra, Revatio
Taking sGC stimulators like Adempas (riociguat)
Severe anemia (low red blood cell count)
People with raised blood pressure in the brain (e.g., brain bleed, traumatic brain injury)
Allergy to other nitrates, such as isosorbide mononitrate (Monoket) or isosorbide dinitrate (Isordil)
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References
Best studies we foundAdvagen Pharma Ltd. (2023). NITROGLYCERIN tablet [package insert]. DailyMed.
Headache Classification Committee of the International Headache
Society (IHS). (2018). The International classification of headache disorders, 3rd edition. Cephalagia.
Ishikura, F., et al. (2000). Effects of sildenafil citrate (Viagra) combined with nitrate on the heart. Circulation.
Koya, H. H., et al. (2023). Shock. StatPearls.
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