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Nitroglycerin Topical

pronounced as(nye troe gli' ser in)

Why is this medication prescribed?

Nitroglycerin ointment is used to prevent episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Nitroglycerin ointment can only be used to prevent attacks of angina; it cannot be used to treat an attack of angina once it has begun. Nitroglycerin is in a class of medications called vasodilators. It works by relaxing the blood vessels so that the heart does not need to work as hard and therefore does not need as much oxygen.

How should this medicine be used?

Topical nitroglycerin comes as an ointment to apply to the skin. It is usually applied twice a day, once right after waking in the morning, and again 6 hours later. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use nitroglycerin ointment exactly as directed. Do not apply more or less of it or apply it more often than prescribed by your doctor.

Your doctor will probably start you on a lower dose of nitroglycerin ointment and may gradually increase your dose as needed to control your angina.

Nitroglycerin ointment may not work as well after it has been used for some time, especially at higher doses. To help prevent this, your doctor will schedule your doses so that there is a period of time when you are not exposed to nitroglycerin every day. If your angina attacks happen more often, last longer, or become more severe at any time during your treatment, call your doctor.

Nitroglycerin ointment helps to prevent angina attacks but does not cure coronary artery disease. Continue to use nitroglycerin ointment even if you feel well. Do not stop using nitroglycerin ointment without talking to your doctor.

Nitroglycerin ointment comes with paper applicator with a ruled line for measuring the dose (in inches). Place the paper on a flat surface and squeeze the ointment onto the paper, carefully measuring the amount specified on your prescription label. If your ointment comes in foil packets, you should know that each packet contains 1 inch of ointment and is to be used for a single dose only. Place the paper on your skin with the ointment side down, and use the paper to lightly spread the ointment to cover an area of skin at least as large as the applicator. Do not rub the ointment into the skin. Tape the applicator in place and cover it with a piece of plastic kitchen wrap to prevent the ointment from staining your clothing. If your ointment comes in a tube, replace the cap and screw it on tightly. If your ointment came in a small foil packet, throw away the packet. Try not to get the ointment on your fingers. Wash your hands after applying the ointment.

Other uses for this medicine

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This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information,

What special precautions should I follow?

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Before using nitroglycerin ointment,

  • tell your doctor and pharmacist if you are allergic to nitroglycerin ointment, tablets, capsules, spray or patches any other medications, or any of the ingredients in nitroglycerin ointment. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: beta blockers such as atenolol (Tenormin), carteolol (Cartrol), labetalol (Normodyne, Trandate), metoprolol (Lopressor), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), and timolol (Blocadren); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem), felodipine (Plendil), isradipine (DynaCirc), nifedipine (Procardia), and verapamil (Calan); dihydroergotamine (D.H.E. 45); medications for high blood pressure, heart failure, mental illness, and nausea; and phosphodiesterase (PDE-5) inhibitors such as sildenafil (Viagra) tadalafil (Cialis), and vardenafil (Levitra). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you think you may be dehydrated, if you have recently had a heart attack, and if you have or have ever had low blood pressure, heart failure, or hypertrophic cardiomyopathy (thickening of the heart muscle).
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using nitroglycerin ointment, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are using nitroglycerin ointment.
  • ask your doctor about the safe use of alcoholic beverages while you are using nitroglycerin ointment. Alcohol can make the side effects from nitroglycerin ointment worse.
  • you should know that nitroglycerin patches 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. To avoid this problem, get up slowly, resting your feet on the floor for a few minutes before standing up. Take extra precautions to avoid falling during your treatment with nitroglycerin.
  • you should know that you may experience headaches every day during your treatment with nitroglycerin ointment. These headaches may be a sign that the medication is working as it should. Do not try to change the times or the way that you apply nitroglycerin ointment in order to avoid headaches because then the medication may not work as well. Your doctor may tell you to take a pain reliever to treat your headaches.

What special dietary instructions should I follow?

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Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

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Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply a double dose to make up for a missed one.

What side effects can this medication cause?

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Nitroglycerin ointment may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • lightheadedness

  • dizziness

  • redness or irritation of the skin that was covered by the ointment

  • flushing

If you experience any of the following symptoms, call your doctor immediately:

  • slow heartbeat

  • worsening chest pain

  • fainting

  • rash

  • hives

  • itching

  • difficulty breathing or swallowing

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What should I know about storage and disposal of this medication?

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Keep this medication out of reach of children. Close the ointment tube tightly after each use. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

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In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

  • headache

  • confusion

  • fever

  • dizziness

  • slow or pounding heartbeat

  • nausea

  • vomiting

  • bloody diarrhea

  • fainting

  • shortness of breath

  • sweating

  • flushing

  • cold, clammy skin

  • loss of ability to move the body

  • coma (loss of consciousness for a period of time)

  • seizures

What other information should I know?

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Keep all appointments with your doctor.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

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  • Nitro-Bid® Ointment

This branded product is no longer on the market. Generic alternatives may be available.

Last Revised - 08/15/2014

ASHP Logo American Society of Health-System Pharmacists, Inc. Disclaimer

AHFS® Consumer Medication Information. © Copyright, 2014. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.