Contraindicated. A: Generally acceptable. I am a 52 year old woman. Minor/Significance Unknown. American Society of Health-System Pharmacists, Inc. Disclaimer, U.S. Department of Health and Human Services. Nitroglycerin is incompatible with heat, ozone, shock, and acids, and is an OSHA Class A Explosive (1910.109) (NIOSH, 2022). Contraindicated. Open your mouth and bring the container as close to it as possible. Do not take more than 3 tablets in 15 minutes. sublingual nitroglycerin should be administered at a dose of 0.4 mg every five minutes for a total of three doses, after which an assessment of blood pressure and pain relief should guide the need for IV nitroglycerin Management of heart failure during pregnancy nitroprusside therapy is required . Let the tablet dissolve completely. Until this clarification, nitroglycerin was classified and handled as RCRA hazardous waste. Use your next dose at the regular time. nitroglycerin IV increases toxicity of dapsone topical by altering metabolism. Contraindicated. Minor/Significance Unknown. If you still have chest pain after a total of 3 tablets, contact your doctor or go to a hospital emergency room right away. Consult your doctor for more details.Lifestyle changes such as dietary changes, exercise, and stopping smoking may help this drug work better. PRECAUTIONS: Before using this medication, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as isosorbide mononitrate); or to nitrites; or if you have any other allergies. nitroglycerin IV increases effects of ergoloid mesylates by decreasing metabolism. Place 1 tablet under your tongue. Avoid areas with cuts or irritation. Take extra precautions to avoid falling during your treatment with nitroglycerin. Use exactly the same steps you used for the first spray. you should know that nitroglycerin may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position, or at any time, especially if you have been drinking alcoholic beverages. Avoid or Use Alternate Drug. Contraindicated. Monitor Closely (1)nitroglycerin IV, benazepril. Topical nitroglycerin comes as an ointment to apply to the skin. Mechanism: additive vasodilation. Most The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Instead, place the tablet under your tongue or between your cheek and gum and wait for it to dissolve. Other formulations which contain nitroglycerin are skin patches and ointment. Properly discard this product when it is expired or no longer needed (See How to Use section). Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. This may be at a location such as a local law enforcement agency, retail pharmacy, hospital or clinic. Nitroglycerin is in a class of medications called vasodilators. Adding plans allows you to compare formulary status to other drugs in the same class. They are prescribed to prevent the pain from developing. Do not chew, crush, or swallow nitroglycerin sublingual tablets. from the best health experts in the business. If this is a new bottle or container, prime the pump before use by releasing a test spray. Contraindicated. Use a different area of skin each time you apply a patch. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Keep all medicines out of the reach and sight of children. Contraindicated (1)dihydroergotamine decreases effects of nitroglycerin IV by pharmacodynamic antagonism. Use glass bottles and non- PVC (polyvinyl chloride) tubing to avoid adsorption of drug to delivery devices; use of PVC tubing in infusion sets may lead to loss of active ingredient due to adsorption of nitroglycerin to PVC tubing; dosage is affected; adsorption by PVC tubing is increased when tubing is long, flow rates are low, and nitroglycerin Do not use more than 3 sprays in 15 minutes. Monitor Closely (1)nitroglycerin IV, arginine. If you suspect that you or someone else might have taken an overdose of this medicine, go to the emergency room of your local hospital. nitroglycerin IV, benazepril. of P-listed waste in a calendar month is categorized by the EPA as a large quantity hazardous waste generator. It relaxes blood vessels in your body (causing them to widen) and this reduces the strain on your heart, making it easier for your heart to pump blood around your body. It is also used just before activities that may cause episodes of angina in order to prevent the angina from occurring. It is important to lift the material up and turn it over to aerate it, as it is the interaction of oxygen with the other materials that causes them to decompose. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines. Consult your doctor for more details. Remember to carry them with you all the time. Is Low-Dose Aspirin Linked to Risk for Gastric Ulcers? Replace the cover after using the medicine. Im very happy to see that this disposal option is once again available to consumers. methylergonovine decreases effects of nitroglycerin IV by pharmacodynamic antagonism. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2RydWcvZ2x5Y2VyeWwtdHJpbml0cmF0ZS1pdi1pdi1uaXRyb2dseWNlcmluLW5pdHJvZ2x5Y2VyaW4taXYtMzQyMjc4, View explanations for tiers and This will allow the fresh ointment to release the nitroglycerin properly. If you have been told by a physician you have low levels of iron in your blood (anemia), or low levels of oxygen in your blood (hypoxemia). include protected health information. Contraindicated. Consult your doctor before breast-feeding. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. This leaves your blood free of nitrate when you are asleep and not needing it, and helps you to get the full benefit from it when you do. Place the tablet under the tongue or between the cheek and gum, and let it dissolve. Talk to your doctor about how to use nitroglycerin tablets to treat angina attacks. This can be thrown into the trash for pick-up. Monitor blood pressure. Modify Therapy/Monitor Closely. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Ask your healthcare professional how you should dispose of any medicine you do not use. Severe side effects that doctors . Never take more than the prescribed dose. US Bio-Clean is an official dealer of Solmetex products, and the Solmetex NXT Hg5 Amalgam Separator meets all federal, state and local compliance requirements. If the headaches continue or become severe, tell your doctor promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension. Moreover, if the waste does not exhibit a characteristic at the point of generation, it is considered to have never been a hazardous waste and does not need to meet land disposal restrictions (LDRs) (66 FR 27286, May 16, 2001). There is also a rectal ointment of nitroglycerin available (Rectiv) but this is used for a completely different condition. Fentanyl patches should be flushed immediately. However, little attention is given to the potential risks, such as accidental exposure or intentional misuse, related to improper medicine disposal. Avoid or Use Alternate Drug. This will make the medication less attractive for pets and children. It is usually caused by narrowing of your coronary arteries due to a build-up of a fatty substance called atheroma. Minor (1)acetylcysteine (Antidote) increases effects of nitroglycerin IV by Other (see comment). Mix the glycerin-soaked material thoroughly through the existing compost by turning it several times with a pitchfork or shovel. If you are taking any other medicines. It works by relaxing the blood vessels so the heart does not need to work as hard and therefore does not need as much oxygen. you should know that nitroglycerin sublingual tablets may not dissolve easily in your mouth if you are taking medications that cause dry mouth such as antihistamines; antidepressants including amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); ipratropium (Atrovent); or medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems. Mechanism: additive vasodilation. It is best not to drink alcohol while you are on nitroglycerin. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. First, remove the medication from their original containers and mix them with some unappealing or foul-tasting items. Use Caution/Monitor. ChildrenUse and dose must be determined by your doctor. Copyright, 2023. If you experience any other symptoms which you think may be due to this medicine, speak with your physician or pharmacist. Wash your hands after applying the patch.You will usually use 1 patch a day and wear it for 12 to 14 hours or as directed by your doctor. Modify Therapy/Monitor Closely. Potentially fatal hypotension. tell your doctor if you think you may be dehydrated and if you have or have ever had heart failure, low blood pressure, or hypertrophic cardiomyopathy (thickening of the heart muscles). Some authorized collection sites may also offer mail-back programs or collection receptacles, sometimes called drop-boxes. Take nitroglycerin exactly as directed. OVERDOSE: This medication patch may be harmful if chewed or swallowed. To overcome this tolerance, your physician may advise you to remove the patch before you go to bed. It will give you more information about the type of formulation you have been given, and it will also provide you with a full list of side-effects which you could experience. If you have ever had an allergic reaction to a medicine. In fact, in 2003 the EPA issued a guidance letter to clear up the hazardous waste listing for this product. A CDER Conversation with Douglas Throckmorton, M.D., Deputy Director for Regulatory Programs, Center for Drug Evaluation and Research, FDA. commonly, these are "non-preferred" brand drugs. Basically, it gives Americans more options to safely get rid of medical products they no longer need. No more than 3 sprays should be given within 15 minutes. Nitroglycerin sublingual tablets are usually taken as needed to treat episodes of angina; do not take them on a regular basis. Both drugs lower blood pressure. nitroglycerin IV, metronidazole. Do not double the dose to catch up. TheEPA determined that the scope of the P081 listingdoes not include medicinal forms of nitroglycerin. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking nitroglycerin sublingual. But there is some good news regarding the proper disposal of medicinal nitroglycerin. ergoloid mesylates decreases effects of nitroglycerin IV by pharmacodynamic antagonism. Follow the schedule of dosing carefully so the medicine will work properly. The vasodilating effects of nitroglycerin may be additive with those of other antihypertensives. While we continue to study the issue, disposal of these select few medicines by flushing has not been shown to cause environmental harm. Risk of increased SBP, angina pectoris. FDA Label, Nitrolingual nitroglycerin spray; Espero Pharmaceuticals Inc. DailyMed, National Institutes of Health, U.S National Library of Medicine. It is also important information to carry with you in case of emergencies. The dosage is based on your medical condition and response to treatment.To reduce skin irritation, apply each new patch to a different area of skin. First, take-back programs. Of course more can be done but so far, Im encouraged by the results I have seen. You should take the extended-release capsule first thing in the morning and follow the same schedule each day. If you have an eye condition called glaucoma. Contraindicated. If the fluid reaches the top or middle of the hole on the side of container, this is an indicator that you must get a refill. Store the oral spray at room temperature, away from heat and direct light. Do not apply the patch immediately after bathing or showering. Release the button and close your mouth, but do not swallow right away. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Make sure laboratory personnel and all your doctors know you use this drug. Contraindicated. Its easy to get confused about the proper disposal of medicinal nitroglycerin due to the categorization of the drug. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, fast/irregular/pounding heartbeat.A very serious allergic reaction to this drug is rare. If you need a third spray, you must wait 5 minutes after the second spray. Overdose. Well, its important to keep medicines in a storage location out of the reach and sight of children and pets too. Either increases effects of the other by pharmacodynamic synergism. Do not drive yourself to the hospital. Your dose may need to be gradually decreased.Although unlikely, when this medication is used for a long time, it may not work as well and may require different dosing. For transdermal dosage form (skin patch): Nitroglycerin in 5% Dextrose Injection is a sterile, nonpyrogenic solution of nitroglycerin and dextrose in water for injection. Access your plan list on any device mobile or desktop. Well, from an agency standpoint, one goal is to educate consumers about the risks of leaving certain unused medicines in the home. IV bags and sets. Mechanism: additive vasodilation. These events are held in many parts of the country and can help you dispose of unused and unneeded drugs quickly and safely. Avoid or Use Alternate Drug. This medicine works best if you have a "drug-free" period of time every day when you do not take it. Potentially fatal hypotension. If you become pregnant while taking nitroglycerin, call your doctor. Most However, you may bathe, shower, and swim while wearing the patch. Dated November 2022. nitroglycerin IV, vardenafil. ergotamine decreases effects of nitroglycerin IV by pharmacodynamic antagonism. If someone has overdosed, remove the patch if possible. Do not use more than 3 sprays in a 15-minute period. Dated August 2018. Contraindicated.Serious - Use Alternative (1)nitroglycerin IV increases effects of ergoloid mesylates by decreasing metabolism. It is also not intended to be used just before physical activities (such as exercise, sexual activity) to prevent chest pain. For most prescription medicines, we recommend they be returned through a local, or U.S. Drug Enforcement Agency-sponsored take-back program or DEA-authorized collector. This legislation is designed to help decrease prescription drug abuse and related crime by allowing patients to turn in controlled substances to an authorized individual or site for collection and destruction. Take the fewest tablets needed to relieve the pain of your attacks. This is because the effect of the medicine lasts for around 20-30 minutes. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. DO NOT CLEAN-UP OR DISPOSE OF, EXCEPT UNDER SUPERVISION OF A SPECIALIST. It is clear that prescription drugs play an important role in managing a range of medical conditions and are widely used in homes across the United States. Contraindicated. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. Please confirm that you would like to log out of Medscape. These facilities must also pay increased fees to regulatory agencies. Monitor blood pressure. You will find a full list in the manufacturer's information leaflet supplied with your medicine. When you are ready to remove the patch, press down on its center to lift the edges away from the skin. If the pain continues for 15 minutes despite using the spray twice then call 911 straightaway. If the pain continues for 15 minutes despite taking the tablets then call 911 straightaway. If this has been prescribed for you, please see a separate medicine leaflet called Glyceryl trinitrate rectal ointment for more information. Either increases effects of the other by additive vasodilation. Do not drive yourself and call 911, if necessary. Before you start the treatment, read the manufacturer's printed information leaflet from inside your pack. Use them to measure the length of ointment squeezed from the tube and to apply the ointment to the skin. nitroglycerin IV, riociguat. Minor/Significance Unknown. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: recent head injury, anemia, low blood pressure, dehydration, other heart problems (such as recent heart attack).This drug may make you dizzy. Each drug may cause hypotension. Either increases effects of the other by pharmacodynamic synergism. Minor (1)nitroglycerin IV decreases effects of heparin by unspecified interaction mechanism. privacy practices. If the first dose does not work, use the spray again after five minutes. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving. Don't swallow or chew the tablet. Okthis act also helps families dispose of drugs that belonged to deceased relatives. Angina chest pain should ease within a few minutes after using nitroglycerin; if the pain does not ease within 15 minutes, call 911. commonly, these are generic drugs. Discuss the risks and benefits with your doctor.It is not known whether this drug passes into breast milk or if it may harm a nursing infant. Where should unused and expired medicines go? tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. Many people prefer to use a spray, as they have a longer shelf life than the tablets. Sadly, we are also aware of four children who have died and another six that required hospitalization from an accidental overdose of the potent pain medicine fentanyl. There are several programs consumers can access to help them dispose of unused or unwanted prescription drugs. Other medications may be needed in these situations. You may administer 1 or 2 sprays of Nitroglycerin oral spray at the onset of chest pain. Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed. Press the patch firmly in place with the palm of your hand. Material Name: Nitroglycerin Tablets (0.4, and 0.6 mg) Trade Name: NITROSTAT; . Nitroglycerin works in two ways. We have received reports of women and children accidentally exposed to testosterone from patches. nitroglycerin IV, arginine. Monitor Closely (1)nitroglycerin IV, bretylium. If you have low blood pressure (hypotension). It relaxes blood vessels in your body (causing them to widen) and this reduces the strain on your heart, making it easier for your heart to pump blood around your body. Additionally, Agrawal et al have proposed an algorithm for nitroglycerin use for the treatment of SCAPE. Individual plans may vary You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. Always place the spray bottle in an upright position if not in use. In case of overdose, call the poison control helpline at 1-800-222-1222. Monitor Closely (1)nitroglycerin IV, bupivacaine implant. To use the sharing features on this page, please enable JavaScript. This drug is available at the lowest co-pay. (e.g., beta-blockers, calcium channel blockers and tricyclic antidepressants) and may cause increased hypotensive effects, Concomitant use of nitroglycerin in 5% dextrose injection concomitant use with phosphodiesterase inhibitors (e.g. Nitroglycerin belongs to a class of drugs known as nitrates. Overall, I think we are making good progress to educate people about the importance of drug disposal and giving them tools to do it. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. Serious - Use Alternative (1)lofexidine, nitroglycerin IV. You may opt-out of email communications at any time by clicking on If you find this is inconvenient, please speak with your physician about using a nitroglycerin spray. Use Caution/Monitor. Upgrade to Patient Pro Medical Professional? 1 tablet may be used every 5 minutes as needed, for up to 15 minutes. Call for emergency medical help right away if your chest pain has not gone away completely 5 minutes after you take the third dose. They work much faster when absorbed through the lining of the mouth. All rights reserved. Nitroglycerin sublingual tablets are used to treat episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). However, because the revised mixture and derived-from rules are less stringent than the existing federal requirements, states which are authorized for the base RCRA program are not required to adopt them [40 CFR 271.1(i)]. If the pain continues for another 5 minutes, a third tablet may be used. For these reasons, before you start taking nitroglycerin it is important that your physician knows: Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. Never give it to other people even if their condition appears to be the same as yours. If you still have chest pain after a total of 3 sprays, contact your doctor or go to a hospital emergency room right away. Contraindicated. By definition, nitroglycerin is listed specifically as hazardous waste under the EPA Resource Conservation and Recovery Act (RCRA). Monitor Closely (1)tetracaine, nitroglycerin IV. This website also contains material copyrighted by 3rd parties. Ready to get started? you should know that you may experience headaches during your treatment with nitroglycerin. have hypotension or uncorrected hypovolemia, as the use of Nitroglycerin in 5% Dextrose Injection in such states could produce severe hypotension or shock; have increased intracranial pressure, for example head trauma or cerebral hemorrhage; have constrictive pericarditis or pericardial tamponade. You may become dizzy, lightheaded, or faint soon after using a tablet or spray, so it is safer to sit rather than stand while the medicine is working. If you miss a dose of this medicine, take it as soon as possible. lofexidine, nitroglycerin IV. The solution is clear and practically colorless. Do not rinse or spit for 5 minutes after taking this medicine. Nitroglycerin Injection is indicated for treatment of peri-operative hypertension; for control of congestive heart failure in the setting of acute myocardial infarction; for treatment of angina pectoris in patients who have not responded to sublingual nitroglycerin and -blockers; and for induction of intraoperative hypotension. This drug is available at a middle level co-pay. Even simple measures like making sure that the safety cap is locked can help prevent accidents. Lightly crush loose leaves and twigs with your hands, drop them into the wheelbarrow, and then mix all this dry material together with a garden fork or, if you . acetylcysteine increases effects of nitroglycerin IV by Other (see comment). If you are taking the nitroglycerin sublingual powder: Empty the contents of a packet under your tongue. It is further categorized as P-listed (P081) or Acutely Toxic. Do not chew, crush, or swallow nitroglycerin sublingual tablets. Instead, the best way to dispose of your medication is through a medicine take-back program. Copyright: Merative US L.P. 1973, 2023. IV nitroglycerin should be started at low doses, 5 to 20 g/min, and titrated up 5 to 10 g every 5 minutes until resolution of angina or control of blood pressure. http://www.upandaway.org. Itis further categorized as P-listed (P081) or Acutely Toxic. Minor/Significance Unknown. Contraindicated (1)methylergonovine decreases effects of nitroglycerin IV by pharmacodynamic antagonism. Your doctor may increase your dose as needed. Sublingual tablets should be kept in the original glass bottle. Information is also available online at https://www.poisonhelp.org/help. Contraindicated (1)nitroglycerin IV, tadalafil. tell your doctor and pharmacist if you are allergic to nitroglycerin patches, capsules, tablets, ointment, or spray; any other medications; or any of the ingredients in nitroglycerin sublingual tablets. The FDA does not endorse this practice for two reasons - first, the medication may have been tampered with and is no longer safe to take, and second, the medication may have been improperly stored and is no longer effective. Unless your doctor tells you otherwise, continue your normal diet. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Hair in the area may be clipped, but not shaved. The best way to dispose of most types * of unused or expired medicines (both prescription and over the counter) is to drop off the medicine at a drug take back site, location, or program. Read our editorial policy. Do not take more than 3 packets in 15 minutes. Contraindicated (1)nitroglycerin IV, riociguat. SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, and flushing may occur as your body adjusts to this medication. All Rights Reserved. Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. If you are in any doubt, check the manufacturer's information leaflet from inside the pack. The EPA has classified most if not all of the nitroglycerin used in healthcare settings as non-hazardous. What special dietary instructions should I follow? acetylcysteine (Antidote) increases effects of nitroglycerin IV by Other (see comment). Also, check the fluid level of Nitromist container regularly. If it is near the time of the next dose, skip the missed dose. This medicine comes with papers to help measure the dose. Contraindicated (1)dihydroergotamine intranasal decreases effects of nitroglycerin IV by pharmacodynamic antagonism. Before sharing sensitive information, make sure you're on a federal government site. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. For details see our conditions. Some patches may contain metals that can cause serious burns during an MRI. This product may contain inactive ingredients, which can cause allergic reactions or other problems. nitroglycerin IV, tadalafil. The .gov means its official.Federal government websites often end in .gov or .mil. nitroglycerin IV increases effects of ergotamine by decreasing metabolism. Mechanism: decreasing metabolism. This should soon pass. Your pain should ease within a minute or so. Do You Need Special Gloves to Handle Medical Waste. Minor (1)acetylcysteine increases effects of nitroglycerin IV by Other (see comment). Screw the cap on tightly after each use and store the bottle at room temperature, away from heat, moisture, and direct light. Excerpt from NIOSH Pocket Guide for Nitroglycerine: It is usual to apply the patches to your chest or upper arm but this may vary depending upon which brand of patches you have been given. In fact, usually more medicine remains in the patch after treatment than was delivered to the patient during treatment. encoded search term (nitroglycerin IV (glyceryl trinitrate IV%2C IV Nitroglycerin)) and nitroglycerin IV (glyceryl trinitrate IV, IV Nitroglycerin), Nitroglycerin: How An Explosive Became a Cardiac Drug, Normal-Tension Glaucoma Linked to Alzheimers Risk, Complementary Pharmacotherapy for STEMI Undergoing Primary PCI, Medscape Cardiologist Wealth & Debt Report 2021. Dextrose is derived from corn. The information on this page is written and peer reviewed by qualified clinicians. An overdose of nitroglycerin may occur when a person uses PDE-5 inhibitors with nitroglycerin or uses too much nitroglycerin during an angina attack. Always ask your health care professional for complete information about this product and your specific health needs. Duplication for commercial use must be authorized by ASHP. Dated February 2018. Remain calm and you should feel better in a few minutes. Tablets and sprays provide rapid relief from the chest pain associated with angina. Adults1 tablet placed under the tongue or between the cheek and gum at the first sign of an angina attack. If you have recently had a head injury or a heart attack. Sprays may be repeated every 5 minutes as needed. You can also place it between your lip and gum, or between your cheek and gum. Then place a sublingual powder or tablet in your mouth or under your tongue. They are used to provide rapid relief from the pain as and when it happens. The following information includes only the average doses of this medicine. Recent use (within several days) of PDE-5 inhibitors (eg, 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, Riociguat; coadministration may cause hypotension, Narrow angle glaucoma (controversial: may not be clinically significant), Symptomatic hypotension, uncorrected hypovolemia, increased intracranial pressure (head trauma, cerebral hemorrhage), severe anemia, constrictive pericarditis, pericardial tamponade, restrictive cardiomyopathy, Use caution in alcohol use, hyperthyroidism, hypertrophic cardiomyopathy, postural hypotension, severe renal impairment, hepatic impairment, Gradually decrease dose to avoid withdrawal reaction, May need 10-12 hr/day nitrate-free interval to avoid tolerance development, Some products contain alcohol and propylene glycol, Remove topical forms when starting IV infusion, Use glass bottles and non-PVC (polyvinyl chloride) tubing to avoid adsorption of drug to delivery devices; use of PVC tubing in infusion sets may lead to loss of active ingredient due to adsorption of nitroglycerin to PVC tubing; dosage is affected; adsorption by PVC tubing is increased when tubing is long, flow rates are low, and nitroglycerin concentration of solution is high; delivered fraction of solution's original nitroglycerin content has been 20-60% in published studies; fraction varies with time during single infusion, and no simple correction factor can be used; if intravenous nitroglycerin is administered through non-adsorptive tubing, doses based upon published reports will generally be too high; some in-line intravenous filters also adsorb nitroglycerin and should be avoided, Solutions containing dextrose without electrolytes should not be administered through the same administration set as blood, as this may result in pseudoagglutination or hemolysis, Intravenous administration of solutions may cause fluid overloading resulting in dilution of serum electrolyte concentrations, overhydration and congested states of pulmonary edema; risk of dilutional states is inversely proportional to electrolyte concentrations of injections; risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to electrolyte concentration of injections, Severe hypotension and shock may occur with even small doses of nitroglycerin; monitor patients who may be volume depleted or, for whatever reason, are already hypotensive; hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris, Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy, Tolerance development and occurrence of cross tolerance to other nitro compounds reported, Administer nitroglycerin in 5% dextrose Injection only via infusion pump that can maintain constant infusion rate, Monitor patients with known sub-clinical or overt diabetes mellitus when using solutions containing dextrose, Cases of methemoglobinemia reported with moderate doses of organic nitrates; when methemoglobinemia is diagnosed, discontinue treatment of nitroglycerin; if condition not reversed, treat with methylene blue, 1-2 mg/kg intravenously, Do not change brands unintentionally as not all are bioequivalent, Treat drug-induced headache with aspirin or acetaminophen, Provide nitrate-free interval (10-12 hr or overnight) to avoid development of tolerance, Use supportive treatment in overdose; there is no specific antidote for overdose; risk of overdose can be minimized by close monitoring during treatment, Lactation: Developmental and health benefits of breastfeeding should be considered along with the mothers clinical need for nitroglycerin and any potential adverse effects on breastfed child from nitroglycerin or from underlying maternal condition.
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