What are examples of Nitroglycerin drugs for the heart?

1 answer | Last updated: Sep 22, 2016
A fellow caregiver asked...

What are examples of Nitroglycerin drugs for the heart?


Expert Answers

Pharmacist William Simonson, also known as "Dr. Si", is a board-certified geriatric pharmacist who is dedicated to improving medication use by seniors. He is a pharmacy educator and is active in publishing and presenting to health professional and consumer audiences and has been active in the area of geriatrics and long-term care pharmacy practice for more than 35 years.

Nitroglycerin is a medicine that has been available for decades and primarily used for the treatment and prevention of angina (chest pain due to reduced blood flow in the arteries to the heart.) Originally it was only made in a small tablet that was placed under the tongue and allowed to dissolve. This is still the dosage form that is preferred by many prescribers for rapid termination of an anginal episode but now there are many different dosage forms available. In fact, I think nitroglycerin is available in a greater variety of different dosage forms that any other drug!

Here is a quick review of the different nitroglycerin dosage forms currently available:

Sublingual tablet: A small white tablet that is placed under the tongue or in the buccal pouch (inside the mouth between the cheek and gum.) It is rapidly dissolved by saliva and absorbed into the blood stream. Relief can be experienced within minutes. Typically, a repeat dosage is placed under the tongue every 5 minutes but if three different doses within a 15 minute time period do not relieve the chest pain prompt medical attention is recommended.

Buccal tablet: This version of nitroglycerin is a tablet that is placed in the buccal pouch (inside the mouth between the cheek and gum) or between the upper lip and gum. The tablet then dissolves slowly which usually takes 3-5 hours. This form of nitroglycerin is for the prevention of angina, not for the reversal of an acute episode of chest pain.

Lingual spray: This dosage form comes in a small bottle of nitroglycerin that is sprayed into the mouth then held in the mouth until it is absorbed (which occurs very quickly.) Relief can be expected within minutes but the dose can be repeated in 3-5 minutes if the pain is not relieved. As with the sublingual tablet, if three doses don't do the trick within 15 minutes, then prompt medical attention is recommended.

Oral capsule: Nitroglycerin is also available in a capsule form that is taken by mouth and swallowed whole. This is an extended-release product that is taken at 8-12 hour intervals for the prevention of angina, not for the reversal of an acute episode.

Topical patch: It is also available in a transdermal system (a skin patch that contains nitroglycerin). This form is a sticky patch containing nitroglycerin that is applied to the skin, usually to a hairless area on the upper arm or body, and allowed to remain in place to allow the drug to be absorbed into the blood stream. It may be removed and replaced by a new patch every 24 hours but sometimes your doctor will want you to remove the patch after 12 hours to allow the nitroglycerin to be cleared from the body (this might improve the effect of the next patch that is applied.)

Topical ointment: Finally, nitroglycerin comes in a tube as an ointment that is applied to the skin, usually the chest, for the long-term prevention of angina. The ointment is typically applied on the chest with a special applicator that is provided with the prescription to prevent absorption of the drug through the fingers. After it is spread on the skin the ointment should not be rubbed or massaged into the skin. It can be a little messy so after application it can be covered with a sheet of plastic kitchen wrap and held in place with an elastic bandage.

Nitroglycerin is also available to be given by an intravenous injection but that is limited only to the hospital and is used for conditions other than angina including severe high blood pressure and after a heart attack so that's all I'll say about this dosage form.

So, you can see that nitroglycerin comes in a wide variety of dosage forms that allow patients and prescribers to decide on the form that best meets the patient's needs. Chest pain can be a sign of a serious medical condition so anyone experiencing chest pain should be under the care of a doctor.