Nitroglycerin Spray

WHY is this medicine prescribed?

Nitroglycerin spray is 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). The spray may also be used just before activities that may cause episodes of angina in order to prevent the angina from occurring. Nitroglycerin is in a class of medications called vasodilators. 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.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Nitroglycerin comes as a spray to use on or under the tongue. The spray is usually used as needed, either 5 to 10 minutes before activities that may cause attacks of angina or at the first sign of an attack. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use nitroglycerin exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Nitroglycerin may not work as well after you have used it for some time or if you have used many doses. Use the fewest number of sprays needed to relieve the pain of your attacks. If your angina attacks happen more often, last longer, or become more severe at any time during your treatment, call your doctor.

Talk to your doctor about how to use nitroglycerin spray to treat angina attacks. Your doctor will probably tell you to sit down and use one dose of nitroglycerin when an attack begins. If your symptoms do not improve very much or if they worsen after you use this dose you may be told to call for emergency medical help right away. If your symptoms do not go away completely after you use the first dose, your doctor may tell you to use a second dose after 5 minutes have passed and a third dose 5 minutes after the second dose. Call for emergency medical help right away if your chest pain has not gone away completely 5 minutes after you use the third dose.

To use the spray, follow these steps:

1. Sit down if possible, and hold the container without shaking it. Remove the plastic cap.
2. If you are using the container for the first time, hold the container upright so that it is pointed away from yourself and others, and press the button 10 times when using Nitromist or 5 times when using Nitrolingual pumpspray to prime the container. If you are not using the container for the first time but have not used it within 6 weeks, press the button 2 times to reprime the container when using Nitromist or 1 time when using Nitrolingual pumpspray. If Nitrolingual has not been used in 3 months or longer, press the button up to 5 times to re-prime the container.
3. Open your mouth. Hold the container upright, as close to your mouth as possible.
4. Use your forefinger to press the button firmly. This will release a spray into your mouth. Do not inhale the spray.
5. Close your mouth. Do not spit out the medication or rinse your mouth for 5 to 10 minutes.
6. Replace the plastic cap on the container.
7. Check the level of liquid in the container from time to time to be sure that you will always have enough medication on hand. Hold the container upright while you are checking. If the liquid reaches the top or middle of the hole on the side of the container, you should order more medication. If the liquid is at the bottom of the hole, the container will no longer dispense full doses of medication.

Do not try to open the container of nitroglycerin spray. This product may catch fire, so do not use near an open flame, and do not allow the container to be burned after use.

What SPECIAL PRECAUTIONS should I follow?

Before using nitroglycerin,

• tell your doctor and pharmacist if you are allergic to nitroglycerin patches, tablets, ointment, or spray; any other medications; or any of the ingredients in nitroglycerin tablets or spray. Ask your pharmacist for a list of the ingredients.

• tell your doctor if you are taking riociguat (Adempas) or if you are taking or have recently taken a phosphodiesterase inhibitor (PDE-5) such as avanafil (Stendra), sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis), and vardenafil (Levitra, Staxyn). Your doctor may tell you not to use nitroglycerin if you are taking one or more of these medications.

• 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: aspirin; beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol-XL), nadolol (Corgard, in Corzide), propranolol (Hemangeol, Inderal LA, Innopran XL), sotalol (Betapace, Sorine), and timolol; calcium channel blockers such as amlodipine (Norvasc, in Tekamlo), diltiazem (Cardizem, Cartia, Dilacor, others), felodipine (Plendil), isradipine, nifedipine (Adalat CC, Afeditab, Procardia), and verapamil (Calan, Covera, Verelan, others); ergot-type medications such as bromocriptine (Cycloset, Parlodel), cabergoline, dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine, ergotamine (Ergomar, in Cafergot, in Migergot), methylergonovine (Methergine), methysergide (Sansert; no longer available in U.S.), and pergolide (Permax; no longer available in U.S.); medications for high blood pressure, heart failure, or an irregular heartbeat. 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 have anemia (a lower than normal number of red blood cells), or have had any condition that increases the pressure in your brain or skull. Your doctor may tell you not to use nitroglycerin.

• 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 breastfeeding. If you become pregnant while using nitroglycerin, call your doctor.

• you should know that you may experience headaches during your treatment with nitroglycerin. These headaches may be a sign that the medication is working as it should. Do not try to change the times that you use nitroglycerin in order to avoid headaches because then the medication may not work as well.

• ask your doctor about the safe use of alcoholic beverages while you are using nitroglycerin. Alcohol can make the side effects from nitroglycerin worse.

What SPECIAL DIETARY instructions should I follow?

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

What should I do IF I FORGET to take a dose?

Nitroglycerin spray is usually used as needed to treat episodes of angina; do not use it on a regularly scheduled basis.

What SIDE EFFECTS can this medicine cause?

Nitroglycerin may cause side effects. Tell your doctor if any of these symptoms or those listed in the SPECIAL PRECAUTIONS section are severe or do not go away:

• flushing
• fast or pounding heartbeat

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment:

• rash, blistering, or peeling of the skin
• nausea
• vomiting
• weakness
• sweating
• pale skin

Nitroglycerin may cause other side effects. Call your doctor if you have any unusual problems while you are using this medication.

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 (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• headache
• confusion
• fever
• dizziness
• changes in vision
• 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?

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.