Nitroglycerin Translingual

Nitroglycerin translingual is used to treat and prevent angina (chest pain).

Nitroglycerin translingual is available under the following different brand names: Nitrolingual, glyceryl trinitrate translingual spray, and NitroMist.

Dosages of Nitroglycerin Translingual:

Dosage Forms and Strengths

Spray

• 0.4mg/spray

Dosage Considerations – Should be Given as Follows:

Angina

• 1-2 spray(s) as needed for angina, may repeat every 3-5 minutes, not to exceed 3 sprays in 15 minutes
• Spray onto or under the tongue; do not inhale, expectorate or rinse the mouth for 5-10 minutes
• Seek medical attention if pain persists after 3 doses in 15 minutes

Angina, Prophylaxis

• 1-2 sprays 5-10 minutes before activities likely to cause angina

Renal Failure

• CrCl: 10-50 mg/minute: Administer every 24-72 hours
• CrCl less than 10 mL/minute: Administer every 72-96 hours
• Not approved for use in pediatric patients

Common side effects of nitroglycerin translingual include:

• Headache
• Low blood pressure (hypotension)
• Fast heart rate
• Dizziness
• Lightheadedness
• Blurred vision
• Flushing
• Nausea
• Vomiting
• Nervousness
• Dry mouth

Serious side effects of nitroglycerin translingual include:

• Methemoglobinemia (rare)
• Lightheadedness/fainting
• Prolonged bleeding time
• Exfoliative dermatitis
• Unstable angina
• Rebound high blood pressure (hypertension)
• Low blood platelets (thrombocytopenia)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Severe interactions of nitroglycerin translingual include:
  • avanafil
  • bromocriptine
  • cabergoline
  • dihydroergotamine
  • dihydroergotamine intranasal
  • ergoloid mesylates
  • ergotamine
  • methylergonovine
  • riociguat
  • sildenafil
  • tadalafil
  • vardenafil
• Serious interactions of nitroglycerin translingual include:
  • cabergoline
  • ergoloid mesylates
  • ergotamine
  • lofexidine
  • methylergonovine
• Moderate interactions of nitroglycerin translingual include:
  • arginine
  • bretylium
  • dapsone topical
  • tetracaine
• Mild interactions of nitroglycerin translingual include:
  • acetylcysteine
  • acetylcysteine (Antidote)
  • ethanol

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

• This medication contains nitroglycerin translingual. Do not take Nitrolingual, glyceryl trinitrate translingual spray, or NitroMist if you are allergic to nitroglycerin translingual or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity
• Heart attack, severe anemia
• Recent use (within several days) of PDE-5 inhibitors (e.g., avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life
• Soluble guanylate cyclase (sGC) stimulator, riociguat; coadministration may cause hypotension
• Narrow-angle glaucoma (controversial: may not be clinically significant)
• Increased intracranial pressure
• Circulatory failure or shock

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Nitroglycerin Translingual?”

Long-Term Effects

• See "What Are Side Effects Associated with Using Nitroglycerin Translingual?”

Cautions

• Congestive heart failure, alcohol use, glaucoma, hyperthyroidism, hypertrophic cardiomyopathy, increased intracranial pressure (e.g., head trauma, cerebral hemorrhage; potential contraindication), increased intraocular pressure (IOP), postural hypotension, volume depletion, low systolic blood pressure
• Severe hypotension may occur with small doses especially in patients with constrictive pericarditis, aortic or mitral stenosis, volume-depleted patients, or that are already hypotensive; hypotension may be accompanied by paradoxical bradycardia and/or increased angina pectoris
• Do not change brands unintentionally as not all are bioequivalent
• Treat drug-induced headache with aspirin or acetaminophen
• Provide nitrate-free interval (10-12 hours or overnight) to avoid the development of tolerance; excessive use may lead to the development of tolerance
• Inability to relieve chest pain after 3 doses may mean acute myocardial infarction (heart attack)-rush to the emergency room if possible
• Discontinue if blurred vision develops
• Prime pump before first use or after prolonged nonuse
• Use supportive treatment in overdose
• May aggravate angina caused by hypertrophic obstructive cardiomyopathy
• Nitroglycerin produces dose-related headaches, especially at the start of nitroglycerin therapy, which may be severe and persistent but usually subside with continued use
• Dose selection for the elderly should start at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant disease or another drug therapy

Pregnancy and Lactation

• Use nitroglycerin translingual with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
• It is not known if nitroglycerin translingual crosses into breast milk. Use caution while breastfeeding.