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NITRATES Sublingual, Chewable, or Buccal (Systemic)
Some commonly used brand names are:
In the U.S.—
Another commonly used name is:
Nitrates (NYE-trates) are used to treat the symptoms of angina (chest pain). Depending on the type of dosage form and how it is taken, nitrates are used to treat angina in three ways:
Nitrates are available in different forms. Sublingual nitrates are generally placed under the tongue where they dissolve and are absorbed through the lining of the mouth. Some can also be used buccally, being placed under the lip or in the cheek. The chewable dosage forms, after being chewed and held in the mouth before swallowing, are absorbed in the same way. It is important to remember that each dosage form is different and that the specific directions for each type must be followed if the medicine is to work properly .
Nitrates that are used to relieve the pain of an angina attack include:
Those that can be used to prevent expected attacks of angina include:
Products that are used regularly on a long-term basis to reduce the number of attacks that occur include:
Nitrates work by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its work load.
Nitrates may also be used for other conditions as determined by your doctor.
The nitrates discussed here are available only with your doctor"s prescription, in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For nitrates, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to nitrates or nitrites. Also tell your health care professional if you are allergic to any other substances, such as certain foods, preservatives, or dyes.
Pregnancy—Nitrates have not been studied in pregnant women. However, studies in rabbits given large doses of isosorbide dinitrate have shown adverse effects on the fetus. Before taking these medicines, make sure your doctor knows if you are pregnant or if you may become pregnant.
Breast-feeding—It is not known whether these medicines pass into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking these medicines and who wish to breast-feed should discuss this with their doctor.
Children—Studies on these medicines have been done only in adult patients, and there is no specific information comparing use of nitrates in children with use in other age groups.
Older adults—Dizziness or lightheadedness may be more likely to occur in the elderly, who may be more sensitive to the effects of nitrates.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking nitrates, it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of nitrates. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
Take this medicine exactly as directed by your doctor . It will work only if taken correctly.
Sublingual tablets should not be chewed, crushed, or swallowed . They work much faster when absorbed through the lining of the mouth. Place the tablet under the tongue, between the lip and gum, or between the cheek and gum and let it dissolve there. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving.
Buccal extended-release tablets should not be chewed, crushed, or swallowed . They are designed to release a dose of nitroglycerin over a period of hours, not all at once.
Chewable tablets must be chewed well and held in the mouth for about 2 minutes before you swallow them . This will allow the medicine to be absorbed through the lining of the mouth.
For patients using nitroglycerin or isosorbide dinitrate to relieve the pain of an angina attack :
For patients using nitroglycerin or isosorbide dinitrate to prevent an expected angina attack :
For patients using isosorbide dinitrate or extended-release buccal nitroglycerin regularly on a long-term basis to reduce the number of angina attacks that occur :
Dosing—The dose of nitrates will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of nitrates. If your dose is different, do not change it unless your doctor tells you to do so.
Missed dose—For patients using isosorbide dinitrate or extended-release buccal nitroglycerin regularly on a long-term basis to reduce the number of angina attacks that occur:
Stability and proper storage—For sublingual nitroglycerin
For isosorbide dinitrate and buccal extended-release nitroglycerin
Precautions While Using This Medicine
Do not take sildenafil (e.g., Viagra), tadalafil (e.g., Cialis), or vardenafil (e.g., Levitra) if you are taking this medicine. When sildenafil, tadalafil, or vardenafil are taken with nitrates, the combination can lower blood pressure and cause dizziness, lightheadedness, or fainting. In some cases, sildenafil, tadalafil, or vardenafil taken with nitrates has caused death .
If you have been taking this medicine regularly for several weeks, do not suddenly stop using it . If you are taking sildenafil, tadalafil, or vardenafil and you experience an angina attack, you must go to the hospital right away. Stopping suddenly may bring on attacks of angina. Check with your doctor for the best way to reduce gradually the amount you are taking before stopping completely.
Dizziness, lightheadedness, or faintness may occur , especially when you get up quickly from a lying or sitting position. Getting up slowly may help. If you feel dizzy, sit or lie down.
The dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for long periods of time, exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time .
After taking a dose of this medicine you may get a headache that lasts for a short time. This is a common side effect , which should become less noticeable after you have taken the medicine for a while. If this effect continues or if the headaches are severe, check with your doctor.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Blurred vision; dryness of mouth; headache (severe or prolonged); skin rash
Signs and symptoms of overdose (in the order in which they may occur)
Bluish-colored lips, fingernails, or palms of hands; dizziness (extreme) or fainting; feeling of extreme pressure in head; shortness of breath; unusual tiredness or weakness; weak and fast heartbeat; fever; convulsions (seizures)
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
Dizziness or lightheadedness, especially when getting up from a lying or sitting position; fast pulse; flushing of face and neck; headache; nausea or vomiting; restlessness
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
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