Nitroglycerin Sublingual

WHY is this medicine prescribed?

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). It is also 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 sublingual tablet to take under the tongue. The tablets is usually taken 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. Take nitroglycerin exactly as directed. Do not take more or less of it or take 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 taken many doses. Take the fewest tablets 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 tablets to treat angina attacks. Your doctor will probably tell you to sit down and take one dose of nitroglycerin when an attack begins. If your symptoms do not improve very much or if they worsen after you take this dose you may be told to call for emergency medical help right away. If your symptoms do not go away completely after you take the first dose, your doctor may tell you to take 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 take the third dose.

Do not chew, crush, or swallow nitroglycerin sublingual tablets. Instead, place the tablet under your tongue or between your cheek and gum and wait for it to dissolve. You may feel burning or tingling in your mouth as the tablet dissolves. This is normal but is not a sign that the tablet is working. Do not be concerned that the tablet is not working if you do not feel the burning or tingling.

What SPECIAL PRECAUTIONS should I follow?

Before taking or using nitroglycerin,

• 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. Ask your pharmacist for a list of the ingredients.

• some medications should not be taken with nitroglycerin. Other medications may cause dosing changes or extra monitoring when taken with nitroglycerin. Make sure you have discussed any medications you are currently taking or plan to take before starting nitroglycerin with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking nitroglycerin, please get the advice of your doctor or pharmacist.

• the following nonprescription product may interact with nitroglycerin: aspirin. Be sure to let your doctor and pharmacist know that you are taking this medication before you start taking or using nitroglycerin. Do not start this medication while taking or using nitroglycerin without discussing with your healthcare provider.

• 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. If this happens, use an artificial saliva product or chew gum to increase the amount of saliva in your mouth so that the tablet will dissolve.

• tell your doctor if you have recently had a heart attack and if you have anemia (low number of red blood cells) or any condition that causes increased pressure in your skull. Your doctor may tell you not to take nitroglycerin.

• 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).

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking nitroglycerin, call your doctor.

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

• 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. 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 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 take nitroglycerin in order to avoid headaches because then the medication may not work as well.

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 sublingual tablets are usually taken as needed to treat episodes of angina; do not take them on a regular 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 SPECIAL PRECAUTIONS section are severe or do not go away:

• flushing

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

• blurred vision
• dry mouth
• rash, blistering, or peeling of the skin
• hives
• itching
• difficulty breathing or swallowing
• nausea
• vomiting
• weakness
• sweating
• pale skin

Nitroglycerin sublingual may cause other side effects. Call your doctor if you have any unusual problems while you are taking 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 after each use, 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
• slow or pounding heartbeat
• vision changes
• 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.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking nitroglycerin sublingual.

Do not let anyone else take 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.