What do I need to know about nitrates?

        Health | Heart

Nitrates are commonly known as nitroglycerin. Nitroglycerin is available in tablet and capsule form. It may also be available in patches that you place on the skin or as a cream. Some rapid-acting forms of nitroglycerin are meant to be dissolved under the tongue or sprayed in the mouth.

When are nitrates prescribed?

Doctors often prescribe nitroglycerin tablets to ease the pain of angina. They also use it to prevent angina from occurring at all. Your doctor may also prescribe nitroglycerin to help you recover from a heart attack.

Common Names of Nitrates

The following table shows some common brand and generic names for nitrates.

brand generic
Deponit nitroglycerin transdermal systems
Dilatrate-SR isosorbide dinitrate, long-acting
Imdur isosorbide mononitrate, oral
Ismo isosorbide mononitrate, oral
Isordil isosorbide dinitrate, long-acting
Isordil Tembids isosorbide dinitrate, long-acting
Isordil Titradose isosorbide dinitrate, long-acting
Isordil, sublingual isosorbide dinitrate, fast-acting
Minitran nitroglycerin transdermal systems
Monoket isosorbide mononitrate, oral
Nitro-Bid ointment nitroglycerin, topical
Nitrodisc nitroglycerin transdermal systems
Nitro-Dur nitroglycerin transdermal systems
Nitrolingual nitroglycerin, fast-acting
Nitrostat nitroglycerin, fast-acting
Sorbitrate isosorbide dinitrate, long-acting
Sorbitrate, sublingual and chewable isosorbide dinitrate, fast-acting
Transderm-Nitro nitroglycerin transdermal systems

How to Use Nitrates

If your doctor prescribed nitroglycerin that you put under your tongue only when you have chest pain, you should follow these instructions.

  • Keep your tablets with you at all times.
  • Store your tablets in their original container, tightly closed. If these pills are not kept away from heat, light, and moisture, they lose their effectiveness.
  • Check the pills' expiration date from time to time, and make sure you have new pills on hand before your current pills expire.
  • If you develop chest pain, first sit down or lie down.
  • Place the pill under your tongue. It will dissolve quickly. Do not chew, crush, or swallow the pill.
  • If your pain has not disappeared within 5 minutes, your doctor may have instructed you to put another pill under your tongue. If your pain still has not disappeared within 5 minutes after the second pill, your doctor may have instructed you to use another pill. Follow your doctor's instructions. Do not take more than three pills in 15 minutes.
  • You should not still have any chest pain after taking the number of pills your doctor has said you should. But if you do, call or ask someone else to call for emergency medical help.

You can also take nitroglycerin in long-acting forms, such as capsule, tablet, patch, and cream. These forms prevent angina from occurring by increasing the blood flow to the heart. Take them regularly as prescribed. If you have angina pain while you are on these, you should still use your nitroglycerin tablets under your tongue if your doctor has prescribed them. If you are still having chest pains while taking one of the long-acting forms of nitrates, then tell your doctor right away. You might need an increased dose or a change in your medicine.

How Nitrates Work

Nitrates widen, or dilate, the coronary arteries. Wider arteries allow more blood to flow to the heart. Nitrates also widen veins. That allows a slowed return of blood to the heart, which decreases the heart's demand for oxygen.

Precautions and Possible Side Effects of Nitrates

Precautions to take when you are on nitrates:
  • Tell your doctor if you have other medical conditions. Conditions that are especially key to mention are the following:
    • severe anemia
    • bronchitis
    • glaucoma
    • recent head trauma
  • Keep your regular appointments with your doctor. It's during your checkup visits that your doctor will monitor your progress while you take these medicines.

Possible side effects. The biggest problem you may have when taking nitroglycerin is dizziness. This occurs when you stand up from a sitting or lying down position. This type of dizziness is called orthostatic hypotension. If your doctor tells you that you have low blood pressure, this medicine might not be right for you.

In addition to dizziness, some people report:

  • flushing
  • headache
  • rapid heart rate

If you develop headaches as a side effect of taking nitrates, ask your doctor what you can safely take to relieve your pain.

Possible Drug Interactions With Nitrates

Before you take a nitrate, tell all of your doctors and your pharmacist about all the medicines you take. Include medicines you take for your blood pressure as well as for any other problem. Tell them about everything you take and how much you take each day, including all of the following:

  • prescription medicines
  • over-the-counter medicines
  • herbs
  • vitamin and mineral supplements

It's best to keep an updated list of these and bring a copy to give to your doctor. That way you can add to it whenever you take something new or delete the types you no longer take. Make a copy for each of your doctors so that they can keep it in your file. This complete list helps your doctor be better prepared to prescribe a nitrate that is the least likely to interact with your other treatments.

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